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Individual

MS. STEPHANIE LYNN MARTIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1185 TOWN CENTRE DR STE 205, EAGAN, MN 55123-1370
(612) 871-1145
Mailing address
1185 TOWN CENTRE DR STE 205, EAGAN, MN 55123-1370
(612) 871-1145

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13826
MN
363A00000X
Physician Assistant
4669-23
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790340552
WI
Enumeration date
05/07/2019
Last updated
10/28/2021
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