Individual
AMY L MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
145 NE BROADWAY ST, MYRTLE CREEK, OR 97457-9039
(541) 677-7200
Mailing address
145 NE BROADWAY ST, MYRTLE CREEK, OR 97457-9039
(541) 677-7200
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
105883
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
THW000105883
—
OR
Enumeration date
01/05/2022
Last updated
01/05/2022
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