Provider Demographics
NPI:1467284562
Name:MARTIN, FALISA LATRESE
Entity type:Individual
Prefix:
First Name:FALISA
Middle Name:LATRESE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10157 ROLAN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-8104
Mailing Address - Country:US
Mailing Address - Phone:313-333-9711
Mailing Address - Fax:
Practice Address - Street 1:10157 ROLAN MEADOWS DR
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-8104
Practice Address - Country:US
Practice Address - Phone:313-333-9711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider