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NPI Code Detail

MEDICARE: SANDRA MARTINI

MEDICARE:   SANDRA  MARTINI
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
1163W00000XRegistered Nurse4704243487MI

General Provider Information

NPI Number : 1558718940
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA MARTINI
Provider Business Mailing Address
First Line : 7306 ROUND LAKE RD NW
Second Line :
City : RAPID CITY
State : MI
Zip : 49676-9494
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7306 ROUND LAKE RD NW
Second Line :
City : RAPID CITY
State : MI
Zip : 49676-9494
Country : US
Telephone Number : 231-676-7193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2016
Last Update Date : 05/16/2016

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Directions to “ SANDRA MARTINI ” Practice Location

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