Provider Demographics
NPI:1639384506
Name:MARTIN, DEBORAH CHRISTINE (RNC, NNP)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:CHRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RNC, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 JARDIN CERCLE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-4708
Mailing Address - Country:US
Mailing Address - Phone:618-978-8174
Mailing Address - Fax:
Practice Address - Street 1:9515 HOLY CROSS LN
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3618
Practice Address - Country:US
Practice Address - Phone:618-526-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112468363LN0005X
IL209012640363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care