Healthcare Provider Details

I. General information

NPI: 1598093254
Provider Name (Legal Business Name): VALESKA L MARTIN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WELLNESS WAY STE A
TOPSHAM ME
04086-1768
US

IV. Provider business mailing address

1 WELLNESS WAY STE A
TOPSHAM ME
04086-1768
US

V. Phone/Fax

Practice location:
  • Phone: 207-406-7600
  • Fax: 207-406-7601
Mailing address:
  • Phone: 207-406-7600
  • Fax: 207-406-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR052983
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP091061
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP91061
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: