Provider Demographics
NPI:1598942443
Name:MARTIN, LOUANN M (ARNP)
Entity Type:Individual
Prefix:
First Name:LOUANN
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LOUANN
Other - Middle Name:M
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1415 N WATTS
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:OK
Mailing Address - Zip Code:73662-1310
Mailing Address - Country:US
Mailing Address - Phone:580-928-2044
Mailing Address - Fax:580-928-5660
Practice Address - Street 1:1650 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3046
Practice Address - Country:US
Practice Address - Phone:580-571-8048
Practice Address - Fax:580-571-8085
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0064327363LF0000X
OK64327363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200135740AMedicaid