Provider Demographics
NPI:1821234139
Name:MARTIN, CATHERINE CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:CHRISTINE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:CHRISTINE
Other - Last Name:HEESAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:525 S LAKE AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2362
Mailing Address - Country:US
Mailing Address - Phone:218-740-1174
Mailing Address - Fax:
Practice Address - Street 1:525 S LAKE AVE
Practice Address - Street 2:SUITE 218
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2362
Practice Address - Country:US
Practice Address - Phone:218-740-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 117073-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse