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General NPI Number Information
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NPI Number | 1912592536
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Entity Type | Individual
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Provider Name | SUZANNE RENEE MARTELL NP
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Gender | Female
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Dates
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Enumeration Date | 03/05/2021
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Last Update Date | 03/05/2021
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Provider Practice Location Address
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Address Line | 114 E SOUTH HILLS DR
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City | MARYVILLE
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State | MO
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Zip | 64468-2659
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Country | US
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Telephone | 660-562-4305
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Fax |
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Provider Business Mailing Address
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Address Line | 23425 170TH RD
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City | GRANT CITY
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State | MO
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Zip | 64456-8426
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Country | US
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Telephone | 660-254-3982
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2021007988
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License Number State | MO
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