Provider Demographics
NPI:1144243742
Name:SENNA MARTIN, ELLEN MARY (CNM)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:MARY
Last Name:SENNA MARTIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:S
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC, CNM SERVICE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-653-9303
Mailing Address - Fax:603-650-0902
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC, CNM SERVICE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-653-9303
Practice Address - Fax:603-650-0901
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH031663-23-01367A00000X
VT101-0012743367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006096Medicaid
NH30011590Medicaid
NHP12178Medicare UPIN
NHRE5850Medicare ID - Type Unspecified