Healthcare Provider Details

I. General information

NPI: 1093896300
Provider Name (Legal Business Name): LIBBI SUE MARTINO CNM / WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 EMERALD AVE SUITE 806
KNOXVILLE TN
37917-4502
US

IV. Provider business mailing address

939 EMERALD AVE SUITE 806
KNOXVILLE TN
37917-4502
US

V. Phone/Fax

Practice location:
  • Phone: 865-647-3450
  • Fax: 865-647-3459
Mailing address:
  • Phone: 865-647-3450
  • Fax: 865-647-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPN15906
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: