Healthcare Provider Details

I. General information

NPI: 1962540088
Provider Name (Legal Business Name): LAURA IRENE MARTIN N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 COLBY AVE STE 202
EVERETT WA
98203-2338
US

IV. Provider business mailing address

4310 COLBY AVE STE 202
EVERETT WA
98203-2338
US

V. Phone/Fax

Practice location:
  • Phone: 425-257-9713
  • Fax:
Mailing address:
  • Phone: 425-257-9713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00000700
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: