Provider Demographics
NPI:1992399901
Name:MARTIN, LINDA JEAN
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JEAN
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 1:1050 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:MI
Mailing Address - Zip Code:48893-9336
Mailing Address - Country:US
Mailing Address - Phone:989-289-2771
Mailing Address - Fax:
Practice Address - Street 1:1050 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:MI
Practice Address - Zip Code:48893-9336
Practice Address - Country:US
Practice Address - Phone:989-289-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other