Provider Demographics
NPI:1164197141
Name:MARTIN, ALENA
Entity Type:Individual
Prefix:
First Name:ALENA
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:PO BOX 305361
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00803-5361
Mailing Address - Country:US
Mailing Address - Phone:340-344-1584
Mailing Address - Fax:
Practice Address - Street 1:10-31 ESTATE MARIENDAHL
Practice Address - Street 2:
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-0080
Practice Address - Country:US
Practice Address - Phone:340-344-1584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant