Individual
MARY ANN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2458 S WALNUT ST, BLOOMINGTON, IN 47401-7730
(812) 337-8121
Mailing address
2458 S WALNUT ST, BLOOMINGTON, IN 47401-7730
(812) 337-8121
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11121956
INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS
—
Enumeration date
09/23/2014
Last updated
09/23/2014
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