Provider Demographics
NPI:1598093254
Name:MARTIN, VALESKA L (ANP)
Entity Type:Individual
Prefix:
First Name:VALESKA
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WELLNESS WAY STE A
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1768
Mailing Address - Country:US
Mailing Address - Phone:207-406-7600
Mailing Address - Fax:207-406-7601
Practice Address - Street 1:1 WELLNESS WAY STE A
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1768
Practice Address - Country:US
Practice Address - Phone:207-406-7600
Practice Address - Fax:207-406-7601
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER052983163W00000X
MEAP091061363LA2200X
MECNP91061363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse