Healthcare Provider Details

I. General information

NPI: 1659124238
Provider Name (Legal Business Name): ANNA MARY MARTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA ROYEK

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 05/21/2025
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 10TH AVE S
GREAT FALLS MT
59405-3240
US

IV. Provider business mailing address

1215 WALNUT ST
GREAT FALLS MT
59405-8651
US

V. Phone/Fax

Practice location:
  • Phone: 406-731-8017
  • Fax:
Mailing address:
  • Phone: 814-664-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNUR-APRN-LIC-234268
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: