Provider Demographics
NPI:1780558460
Name:MARTIN, SHARLOTTE LEIGH
Entity type:Individual
Prefix:
First Name:SHARLOTTE
Middle Name:LEIGH
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 1:329 COTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SHEYENNE
Mailing Address - State:ND
Mailing Address - Zip Code:58374-7132
Mailing Address - Country:US
Mailing Address - Phone:701-230-7724
Mailing Address - Fax:
Practice Address - Street 1:329 COTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:SHEYENNE
Practice Address - State:ND
Practice Address - Zip Code:58374-7132
Practice Address - Country:US
Practice Address - Phone:701-230-7724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDLON9239943747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant