Provider Demographics
NPI:1043099542
Name:MARTELLO, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 OHARA DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-9504
Mailing Address - Country:US
Mailing Address - Phone:248-379-7572
Mailing Address - Fax:
Practice Address - Street 1:2029 S ELMS RD STE 101
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-9766
Practice Address - Country:US
Practice Address - Phone:810-285-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program