| NPI | 1942454608 |
|---|---|
| Former Name | MICHELLE RENAE MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: KS 5375286) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2004027607) |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2017-10-19 |