Individual
BRITTANY NICOLE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
720 14TH AVE, LONGVIEW, WA 98632-2315
(360) 423-0203
(360) 577-0187
Mailing address
PO BOX 1847, LONGVIEW, WA 98632-8140
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CG60980160
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CDCA.164311
LICENSURE
OH
Enumeration date
10/26/2017
Last updated
06/22/2022
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