Provider Demographics
NPI:1740906684
Name:MARTIN, COURTENEY ELIZABETH
Entity type:Individual
Prefix:
First Name:COURTENEY
Middle Name:ELIZABETH
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 1:2959 UMI ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1806
Mailing Address - Country:US
Mailing Address - Phone:808-977-3155
Mailing Address - Fax:
Practice Address - Street 1:2959 UMI ST STE 300
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1806
Practice Address - Country:US
Practice Address - Phone:808-651-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist