Individual
MRS. MICHELLE ELAINE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1515 HOMMEN RD, DEERFIELD, WI 53531-9678
(608) 444-0774
Mailing address
175 WATERLOO ST, COLUMBUS, WI 53925-1764
(608) 695-0594
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
301758
WI
Other
Enumeration date
12/22/2021
Last updated
12/22/2021
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