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Individual

ANDREA MARTIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
330 COURT ST, EAGLE RIVER, WI 54521-8362
(715) 479-3656
Mailing address
330 COURT ST, EAGLE RIVER, WI 54521-8362

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
6480-16
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1427347426
WI
Enumeration date
06/10/2014
Last updated
09/21/2015
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