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General NPI Number Information
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NPI Number | 1164245445
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Entity Type | Individual
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Provider Name | KRISTINE LOUISE MARTIN APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 107 12TH ST S
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City | COOPERSTOWN
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State | ND
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Zip | 58425-4501
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Country | US
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Telephone | 701-786-1700
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Fax | 701-786-7122
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Provider Business Mailing Address
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Address Line | 113 3RD AVE NE
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City | MAYVILLE
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State | ND
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Zip | 58257-1220
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Country | US
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Telephone | 701-430-3429
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201116
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License Number State | ND
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