Individual
PATTI L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3333 W DEYOUNG ST, MARION, IL 62959-5884
(618) 998-7000
Mailing address
4750 HEMPSTEAD STATION DR, KETTERING, OH 45429-5164
(800) 875-0136
(937) 619-4231
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209000493
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00317454
RR MEDICARE HEARTLAND
—
Enumeration date
05/05/2006
Last updated
06/16/2008
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