Individual
ILLEXUS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1575 LAUREL AVE APT B, SAINT PAUL, MN 55104-7494
(763) 477-1743
Mailing address
1575 LAUREL AVE APT B, SAINT PAUL, MN 55104-7494
(763) 477-1743
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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