MEDICARE: MARY A MARTIN CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	4704165662	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235119819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A MARTIN CNM

Provider Business Mailing Address
First Line	:	12880 MANNING LAKE RD
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-9659
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12880 MANNING LAKE RD
Second Line	:
City	:	DELTON
State	:	MI
Zip	:	49046-9659
Country	:	US
Telephone Number	:	269-999-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	01/12/2024

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