Individual
ELLEN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
619 N MAIN ST, MUSKOGEE, OK 74401-4431
(918) 682-8407
Mailing address
PO BOX 104, OKTAHA, OK 74450-0104
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0013851
OK
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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