Provider Demographics
NPI:1851833032
Name:MARTIN, ANNA (ND, LMP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ND, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42929 170TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GOLD BAR
Mailing Address - State:WA
Mailing Address - Zip Code:98251-9183
Mailing Address - Country:US
Mailing Address - Phone:425-908-9394
Mailing Address - Fax:360-294-8207
Practice Address - Street 1:42929 170TH ST SE
Practice Address - Street 2:
Practice Address - City:GOLD BAR
Practice Address - State:WA
Practice Address - Zip Code:98251-9183
Practice Address - Country:US
Practice Address - Phone:425-908-9394
Practice Address - Fax:360-294-8207
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-05
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60477523225700000X
WANT60866566175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist