Individual
MAUREEN PATRICIA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13035 W BLUEMOUND RD STE 100, BROOKFIELD, WI 53005-8001
(262) 794-1121
(262) 784-9777
Mailing address
1742 S OSBORNE AVE, JANESVILLE, WI 53546-5720
(608) 447-1071
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M6355555994502
DRIVERS LICENSE
WI
Enumeration date
08/26/2022
Last updated
09/07/2022
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