Healthcare Provider Details

I. General information

NPI: 1851833032
Provider Name (Legal Business Name): ANNA MARTIN ND, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2016
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42929 170TH ST SE
GOLD BAR WA
98251-9183
US

IV. Provider business mailing address

42929 170TH ST SE
GOLD BAR WA
98251-9183
US

V. Phone/Fax

Practice location:
  • Phone: 425-908-9394
  • Fax: 360-294-8207
Mailing address:
  • Phone: 425-908-9394
  • Fax: 360-294-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60477523
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60866566
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: