Provider Demographics
NPI:1285891135
Name:MARTIN, CATHERINE ANNE (RN, CNP)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8547 121ST AVE N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2054
Mailing Address - Country:US
Mailing Address - Phone:763-300-3554
Mailing Address - Fax:
Practice Address - Street 1:10705 TOWN SQUARE DR NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-8184
Practice Address - Country:US
Practice Address - Phone:763-236-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN159406-5163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse