Provider Demographics
NPI:1760867683
Name:AYERS, MARTHE
Entity Type:Individual
Prefix:
First Name:MARTHE
Middle Name:
Last Name:AYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 MISSOURI RIVER CT
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-3789
Mailing Address - Country:US
Mailing Address - Phone:509-424-0743
Mailing Address - Fax:517-423-7772
Practice Address - Street 1:508 MISSOURI RIVER CT
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-3789
Practice Address - Country:US
Practice Address - Phone:509-424-0743
Practice Address - Fax:517-423-7772
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0028573750OtherCIS CUSTOMER ID
MI0001117939OtherCIS CUSTOMER ID