Provider Demographics
NPI:1861706160
Name:LINDSTROM, MARTHA C (NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:C
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:E
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:111 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:731 S. IL-21
Practice Address - Street 2:STE 110
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3204
Practice Address - Country:US
Practice Address - Phone:847-360-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL41341644363L00000X
IL209-008244363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1861706160OtherTRICARE NORTH REGION
ILP00932260OtherMEDICARE RAILROAD
IL1861706160OtherTRICARE NORTH REGION