Individual provider Active NPI

Martha Iris Montanez

  • Licensed Practical Nurse
  • Evanston, IL
National Provider Identifier
1922795103
Registry record updated Apr 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
043.065837 Issued in IL
Practice address
1942 Dempster St
Evanston, IL 60202-1016
Phone
(847) 688-1900
Fax
(847) 869-7392
NPI assigned
Apr 19, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 043.065837 IL Primary

Addresses

Primary practice location

1942 Dempster St
Evanston, IL 60202-1016

Mailing address

1942 Dempster St
Evanston, IL 60202-1016
Phone (847) 688-1900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
043.065837ILMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1922795103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 DEMPSTER ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021016",
            "telephone_number": "847-688-1900",
            "fax_number": "847-869-7392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 DEMPSTER ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602021016",
            "telephone_number": "847-688-1900",
            "fax_number": "847-869-7392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTANEZ",
        "first_name": "MARTHA",
        "middle_name": "IRIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-19",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "IL",
            "license": "043.065837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.