Provider Demographics
NPI:1114266210
Name:MARTIN, LORENA
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:
Last Name:MARTIN
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 1:829 CHIEF EDDIE HOFFMAN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:AK
Mailing Address - Zip Code:99559-0528
Mailing Address - Country:US
Mailing Address - Phone:907-543-6160
Mailing Address - Fax:907-543-6143
Practice Address - Street 1:101 COUNCIL DRIVE
Practice Address - Street 2:
Practice Address - City:KIPNUK
Practice Address - State:AK
Practice Address - Zip Code:99614
Practice Address - Country:US
Practice Address - Phone:907-896-5334
Practice Address - Fax:907-896-5537
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker