Provider Demographics
NPI:1700919982
Name:MARTIN BARTLETT, GAIL DIANE (APRN)
Entity type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:DIANE
Last Name:MARTIN BARTLETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1101 E 37TH ST STE 220
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-2933
Mailing Address - Country:US
Mailing Address - Phone:218-263-8574
Mailing Address - Fax:218-262-1915
Practice Address - Street 1:1101 E 37TH ST STE 220
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2933
Practice Address - Country:US
Practice Address - Phone:218-263-8574
Practice Address - Fax:218-262-1915
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2005001683363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health