Provider Demographics
NPI:1164834438
Name:MARTIEN, MICHEL RICHARD (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:MICHEL
Middle Name:RICHARD
Last Name:MARTIEN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 DIAMOND CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5322
Mailing Address - Country:US
Mailing Address - Phone:337-257-5995
Mailing Address - Fax:
Practice Address - Street 1:116 DIAMOND CREEK DR
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5322
Practice Address - Country:US
Practice Address - Phone:337-257-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMDW.200011176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife