Provider Demographics
NPI:1598078727
Name:MARTIN, LITA ROSE HORST (NP-C)
Entity Type:Individual
Prefix:
First Name:LITA
Middle Name:ROSE HORST
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 JOHN ST STE M-318
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5383
Mailing Address - Country:US
Mailing Address - Phone:269-349-9745
Mailing Address - Fax:269-488-8305
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M-206C
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-349-9745
Practice Address - Fax:269-488-8305
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704206770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008712490OtherBCBS
MI0C97625182Medicare PIN