Provider Demographics
NPI:1588218788
Name:MARTIN, PAULINE E (RN)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:E
Last Name:MARTIN
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 1:2501 NE 134TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686-3028
Mailing Address - Country:US
Mailing Address - Phone:360-940-0820
Mailing Address - Fax:888-468-6693
Practice Address - Street 1:2501 NE 134TH ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-3028
Practice Address - Country:US
Practice Address - Phone:360-940-0820
Practice Address - Fax:888-468-6693
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00096995163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice