| NPI | 1356606768 |
|---|---|
| Former Name | MISTY MARIE MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: SC 23137) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OH RN.251801-COA1) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: OH 251801) | |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2023-02-20 |