Provider Demographics
NPI:1851856827
Name:MARTIN, SUSAN B (RN, CDE)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8030 RESURRECTION DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4731
Mailing Address - Country:US
Mailing Address - Phone:304-216-3290
Mailing Address - Fax:
Practice Address - Street 1:8030 RESURRECTION DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4731
Practice Address - Country:US
Practice Address - Phone:304-216-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK28049163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty