Provider Demographics
NPI:1346837531
Name:MARTIN, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
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 1:163 FELIX ST
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:WI
Mailing Address - Zip Code:53183-9508
Mailing Address - Country:US
Mailing Address - Phone:262-269-9890
Mailing Address - Fax:
Practice Address - Street 1:163 FELIX ST
Practice Address - Street 2:
Practice Address - City:WALES
Practice Address - State:WI
Practice Address - Zip Code:53183-9508
Practice Address - Country:US
Practice Address - Phone:262-269-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No372500000XNursing Service Related ProvidersChore Provider
No385H00000XRespite Care FacilityRespite Care
No251X00000XAgenciesSupports Brokerage