Provider Demographics
NPI:1295468858
Name:MARTINIUK, MARY LOUISE (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:MARTINIUK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:TOK
Mailing Address - State:AK
Mailing Address - Zip Code:99780-0186
Mailing Address - Country:US
Mailing Address - Phone:907-883-4101
Mailing Address - Fax:907-883-4102
Practice Address - Street 1:1314 AK HWY
Practice Address - Street 2:
Practice Address - City:TOK
Practice Address - State:AK
Practice Address - Zip Code:99780
Practice Address - Country:US
Practice Address - Phone:907-883-4101
Practice Address - Fax:907-883-4102
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK128892163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse