Healthcare Provider Details

I. General information

NPI: 1275529935
Provider Name (Legal Business Name): KAREN J MARTIN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677A EAST MAIN
CENTREVILLE MI
49032
US

IV. Provider business mailing address

677A EAST MAIN
CENTREVILLE MI
49032
US

V. Phone/Fax

Practice location:
  • Phone: 269-467-1000
  • Fax: 269-467-3075
Mailing address:
  • Phone: 269-467-1000
  • Fax: 269-467-3075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number4703063032
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: