Healthcare Provider Details

I. General information

NPI: 1396480448
Provider Name (Legal Business Name): NICK VINCENT MARTIN RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2022
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 PLEASANT ST
DES MOINES IA
50309-1406
US

IV. Provider business mailing address

1413 13TH ST SE
BONDURANT IA
50035-4443
US

V. Phone/Fax

Practice location:
  • Phone: 515-241-6212
  • Fax:
Mailing address:
  • Phone: 319-936-0552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: