Provider Demographics
NPI:1508210527
Name:MARTIN, NATALIE (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6390 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-1105
Mailing Address - Country:US
Mailing Address - Phone:925-953-3118
Mailing Address - Fax:
Practice Address - Street 1:G1069 N BALLENGER HWY
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-4431
Practice Address - Country:US
Practice Address - Phone:810-235-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276797363LF0000X
CA774530390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program