Provider Demographics
NPI:1013313790
Name:MARTIN, VIRGINIA JONES (BA, LPN, CLC)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:JONES
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BA, LPN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4393 GREEN MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CO
Mailing Address - Zip Code:80536-8762
Mailing Address - Country:US
Mailing Address - Phone:970-377-4293
Mailing Address - Fax:
Practice Address - Street 1:4393 GREEN MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CO
Practice Address - Zip Code:80536-8762
Practice Address - Country:US
Practice Address - Phone:970-377-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21873164W00000X
174H00000X, 374J00000X
MAALPP28107174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula