Provider Demographics
NPI:1528216462
Name:MARTIN, ELISABETH ANN
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:ANN
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 1:17624 N 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-1935
Mailing Address - Country:US
Mailing Address - Phone:602-467-5910
Mailing Address - Fax:602-467-5980
Practice Address - Street 1:17624 N 31ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-1935
Practice Address - Country:US
Practice Address - Phone:602-467-5910
Practice Address - Fax:602-467-5980
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN122417163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool