Provider Demographics
NPI:1356572333
Name:MARTIN, KARLY IRENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KARLY
Middle Name:IRENE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14772 W HIDDEN CREEK CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4441
Mailing Address - Country:US
Mailing Address - Phone:414-640-0840
Mailing Address - Fax:
Practice Address - Street 1:14772 W HIDDEN CREEK CT
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4441
Practice Address - Country:US
Practice Address - Phone:414-640-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI311424-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse