Provider Demographics
NPI:1093896300
Name:MARTINO, LIBBI SUE (CNM / WHNP)
Entity Type:Individual
Prefix:MS
First Name:LIBBI
Middle Name:SUE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:CNM / WHNP
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:939 EMERALD AVE
Mailing Address - Street 2:SUITE 806
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-4502
Mailing Address - Country:US
Mailing Address - Phone:865-647-3450
Mailing Address - Fax:865-647-3459
Practice Address - Street 1:939 EMERALD AVE
Practice Address - Street 2:SUITE 806
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-4502
Practice Address - Country:US
Practice Address - Phone:865-647-3450
Practice Address - Fax:865-647-3459
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN15906367A00000X
MTRN28035367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTXXXX24Medicare UPIN