Individual
MS. MICHELLE RENEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1032 CROSSWINDS CT, WENTZVILLE, MO 63385-4836
(844) 853-8937
(636) 332-1401
Mailing address
1032 CROSSWINDS CT, WENTZVILLE, MO 63385-4836
(844) 853-8937
(636) 332-1401
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
131957
MO
363LP0200X
Pediatric Nurse Practitioner
Primary
2019012307
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
428968507
—
MO
Enumeration date
05/04/2006
Last updated
07/11/2025
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