Provider Demographics
NPI:1356116339
Name:MARTIN, ANNE ELISE (DNP, ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 KOHLER DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2344
Mailing Address - Country:US
Mailing Address - Phone:563-271-6654
Mailing Address - Fax:
Practice Address - Street 1:5350 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2738
Practice Address - Country:US
Practice Address - Phone:563-355-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA135577163W00000X
IAA177076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse