Provider Demographics
NPI:1487100632
Name:MARTINEZ, SOPHAL (APN)
Entity type:Individual
Prefix:MRS
First Name:SOPHAL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N HIGHLAND AVE
Mailing Address - Street 2:5
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-1451
Mailing Address - Country:US
Mailing Address - Phone:630-301-7366
Mailing Address - Fax:630-301-7369
Practice Address - Street 1:1300 N HIGHLAND AVE
Practice Address - Street 2:5
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-1451
Practice Address - Country:US
Practice Address - Phone:630-301-7366
Practice Address - Fax:630-301-7369
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.380909163W00000X
IL209.014332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse