Healthcare Provider Details

I. General information

NPI: 1740469675
Provider Name (Legal Business Name): CAREN SUZANNE MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 SW WOODWARD AVE
TOPEKA KS
66604-3922
US

IV. Provider business mailing address

1135 SW WOODWARD AVE
TOPEKA KS
66604-3922
US

V. Phone/Fax

Practice location:
  • Phone: 785-215-3921
  • Fax:
Mailing address:
  • Phone: 785-215-3921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number13-55383-081
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: