Individual
AMY MARTINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10000 TELEGRAPH RD, TAYLOR, MI 48180-3330
(313) 295-5007
(313) 295-6725
Mailing address
38935 ANN ARBOR RD, CREDENTIALING DEPT, LIVONIA, MI 48150-3397
(734) 632-0175
(734) 632-0182
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
4704191045
MI
363LA2200X
Adult Health Nurse Practitioner
Primary
4704191045
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12553400
CAQH
MI
Enumeration date
05/20/2013
Last updated
11/04/2024
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