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General NPI Number Information
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NPI Number | 1457422933
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Entity Type | Individual
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Provider Name | SUE C. MARTIN LMP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9106 NE HIGHWAY 99 SUITE E
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City | VANCOUVER
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State | WA
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Zip | 98665-8971
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Country | US
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Telephone | 360-281-1215
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Fax |
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Provider Business Mailing Address
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Address Line | 723 NW 119TH ST
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City | VANCOUVER
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State | WA
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Zip | 98685-3803
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Country | US
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Telephone | 360-574-4052
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00014597
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License Number State | WA
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