Provider Demographics
NPI:1457422933
Name:MARTIN, SUE C (LMP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-3803
Mailing Address - Country:US
Mailing Address - Phone:360-574-4052
Mailing Address - Fax:
Practice Address - Street 1:9106 NE HIGHWAY 99
Practice Address - Street 2:SUITE E
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8971
Practice Address - Country:US
Practice Address - Phone:360-281-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00014597174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist