Provider Demographics
NPI:1164488243
Name:MARTENS, SANDRA L (RD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MARTENS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SANDI
Other - Middle Name:L
Other - Last Name:MARTENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7111 E 21ST ST N STE A
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1078
Mailing Address - Country:US
Mailing Address - Phone:316-684-2851
Mailing Address - Fax:316-683-5239
Practice Address - Street 1:7111 E 21ST ST N STE A
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-684-2851
Practice Address - Fax:316-683-5239
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS000578133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
723310OtherREGISTERED DIETITAN
KSP49382Medicare UPIN
KS120514Medicare ID - Type Unspecified