Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 225000000X | Orthotic Fitter |
NPI | 1124665120 |
---|---|
Provider Name | Debbie Ansay-Martinez |
First Address | Northbrook, IL 60062-6118 |
Second Address | Northfield, IL 60093-2718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2019 |
Last Update Date | 09/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
011250393 | LICENSE (01) | IL |