Provider Demographics
NPI:1447594999
Name:MARTEN, CONNIE SUE (APN)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:SUE
Last Name:MARTEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BELLEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-1448
Mailing Address - Country:US
Mailing Address - Phone:618-316-9423
Mailing Address - Fax:
Practice Address - Street 1:215 W BELLEVILLE ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-1448
Practice Address - Country:US
Practice Address - Phone:618-316-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-22
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012031563163W00000X
IL041.314231163W00000X
IL209009826363L00000X, 363LF0000X
MO2012033369363LF0000X
IL209.009826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner