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NPI Code Detail

MEDICARE: TERESA MARTIN RN

MEDICARE: TERESA MARTIN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse4704205431MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386600328
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERESA MARTIN RN
Provider Business Mailing Address
First Line : 375 APPLE TREE DR
Second Line :
City : IONIA
State : MI
Zip : 48846-7506
Country : US
Telephone Number : 616-527-1790
Fax Number :
Provider Business Practice Location Address
First Line : 375 APPLE TREE DR
Second Line :
City : IONIA
State : MI
Zip : 48846-7506
Country : US
Telephone Number : 616-902-2310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 01/26/2016

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