Provider Demographics
NPI:1184242067
Name:MARTIN, VIOLA MARIE
Entity type:Individual
Prefix:
First Name:VIOLA
Middle Name:MARIE
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 1:929 N HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:MO
Mailing Address - Zip Code:64831-9753
Mailing Address - Country:US
Mailing Address - Phone:417-389-7222
Mailing Address - Fax:
Practice Address - Street 1:929 N HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:MO
Practice Address - Zip Code:64831-9753
Practice Address - Country:US
Practice Address - Phone:417-389-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QH0100X, 385H00000X
3104A0625X
KS18071376K00000X
MO37930A376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No385H00000XRespite Care FacilityRespite Care