MEDICARE: MS. NINA KAY MARTENSON TLLP

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
1	103T00000X	Psychologist	6301014417	MI

General Provider Information

NPI Number	:	1700150638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NINA KAY MARTENSON TLLP

Provider Business Mailing Address
First Line	:	704 GRANT ST
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-1353
Country	:	US
Telephone Number	:	616-550-9343
Fax Number	:

Provider Business Practice Location Address
First Line	:	6250 M 66 N
Second Line	:
City	:	CHARLEVOIX
State	:	MI
Zip	:	49720-9272
Country	:	US
Telephone Number	:	231-547-5885
Fax Number	:	231-547-0136

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2012
Last Update Date	:	02/23/2012

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