Provider Demographics
NPI:1639904006
Name:MARTILLARO, EMILY ANNE (APRN,CNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:MARTILLARO
Suffix:
Gender:F
Credentials:APRN,CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ROOSEVELT RD STE A
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5618
Mailing Address - Country:US
Mailing Address - Phone:630-469-0045
Mailing Address - Fax:630-469-0645
Practice Address - Street 1:285 ROOSEVELT RD STE A
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5618
Practice Address - Country:US
Practice Address - Phone:630-469-0045
Practice Address - Fax:630-469-0645
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.030724363LF0000X
IL209030724363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily