Provider Demographics
NPI:1942721329
Name:MARTIN, LORETTA ANN
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:ANN
Last Name:MARTIN
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 1:6122 N MACARTHUR BLVD APT 164
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-7315
Mailing Address - Country:US
Mailing Address - Phone:405-882-3232
Mailing Address - Fax:405-470-7377
Practice Address - Street 1:6122 N MACARTHUR BLVD APT 1646122N
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73122-7350
Practice Address - Country:US
Practice Address - Phone:405-882-3232
Practice Address - Fax:405-470-7377
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered Meals
No376J00000XNursing Service Related ProvidersHomemaker