Healthcare Provider Details

I. General information

NPI: 1497341580
Provider Name (Legal Business Name): BEVERLY JEAN MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 SPRING ARBOR RD STE 105
JACKSON MI
49203-3791
US

IV. Provider business mailing address

3413 S LINDEN RD
FLINT MI
48507-3018
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-5853
  • Fax:
Mailing address:
  • Phone: 810-733-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: