Individual
MARTENIA MIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN BSHCM MSHS
Contact information
Practice address
619 BENHAM ST, HAMDEN, CT 06514-2656
(475) 655-4159
Mailing address
619 BENHAM ST, HAMDEN, CT 06514-2656
(475) 655-4159
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN09927
RI
164X00000X
Licensed Vocational Nurse
204554
CA
Other
Enumeration date
11/16/2021
Last updated
11/16/2021
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