Individual
CONNIE I. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST
Contact information
Practice address
1101 E MISSOURI AVE, PHOENIX, AZ 85014-2709
(602) 222-2221
(602) 266-2044
Mailing address
PO BOX 32530, PHOENIX, AZ 85064-2530
(602) 222-2221
(602) 266-2044
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
122672
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122672
CST CERTIFICATE NUMBER
AZ
Enumeration date
02/09/2016
Last updated
02/09/2016
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