Provider Demographics
NPI:1790812444
Name:MARTIN, MARTHA ANNA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANNA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:ANNA
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:19B MCALPIN ST
Mailing Address - Street 2:APT.1
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1827
Mailing Address - Country:US
Mailing Address - Phone:518-463-0865
Mailing Address - Fax:
Practice Address - Street 1:12 PETRA LN
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4973
Practice Address - Country:US
Practice Address - Phone:518-452-0445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070503164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse