1093896300 NPI number — MS. LIBBI SUE MARTINO CNM / WHNP

Table of content: MS. LIBBI SUE MARTINO CNM / WHNP (NPI 1093896300)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093896300 NPI number — MS. LIBBI SUE MARTINO CNM / WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINO
Provider First Name:
LIBBI
Provider Middle Name:
SUE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM / WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093896300
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
939 EMERALD AVE
Provider Second Line Business Mailing Address:
SUITE 806
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37917-4502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-647-3450
Provider Business Mailing Address Fax Number:
865-647-3459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
939 EMERALD AVE
Provider Second Line Business Practice Location Address:
SUITE 806
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37917-4502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-647-3450
Provider Business Practice Location Address Fax Number:
865-647-3459
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  APN15906 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com