MEDICARE: MARIA MARTIN

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	164W00000X	Licensed Practical Nurse	317599-31	WI

General Provider Information

NPI Number	:	1851718019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA MARTIN

Provider Business Mailing Address
First Line	:	7318 W VALLEY RIDGE DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-2356
Country	:	US
Telephone Number	:	608-219-8517
Fax Number	:

Provider Business Practice Location Address
First Line	:	7318 W VALLEY RIDGE DR
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53719-2356
Country	:	US
Telephone Number	:	608-219-8517
Fax Number	:

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

Provider Enumeration Date	:	03/26/2014
Last Update Date	:	03/26/2014

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Directions to “ MARIA MARTIN ” Practice Location

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