Provider Demographics
NPI:1538285861
Name:ROSS-CHATMAN, MARTRILLA MARIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARTRILLA
Middle Name:MARIE
Last Name:ROSS-CHATMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17650 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1911
Mailing Address - Country:US
Mailing Address - Phone:313-717-3484
Mailing Address - Fax:313-871-9950
Practice Address - Street 1:17650 W 12 MILE RD
Practice Address - Street 2:514 ALGER
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1911
Practice Address - Country:US
Practice Address - Phone:313-717-3484
Practice Address - Fax:313-871-9950
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704131804163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704131804OtherNURSING LICENSE