Provider Demographics
NPI:1801081088
Name:MARTIN, MICHELLE REAAN (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:REAAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 307
Mailing Address - Street 2:ASHER HOME HEALTH SERVICES
Mailing Address - City:FOSSIL
Mailing Address - State:OR
Mailing Address - Zip Code:97830-0307
Mailing Address - Country:US
Mailing Address - Phone:541-763-2725
Mailing Address - Fax:541-763-2850
Practice Address - Street 1:712 JAY STREET
Practice Address - Street 2:
Practice Address - City:FOSSIL
Practice Address - State:OR
Practice Address - Zip Code:97830
Practice Address - Country:US
Practice Address - Phone:541-763-2725
Practice Address - Fax:541-763-2850
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health