Provider Demographics
NPI:1144560947
Name:MARTIN, CORRIE ANN (RN)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8427 MAPLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-7805
Mailing Address - Country:US
Mailing Address - Phone:810-407-4458
Mailing Address - Fax:
Practice Address - Street 1:8427 MAPLEVIEW DR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-7805
Practice Address - Country:US
Practice Address - Phone:810-407-4458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4074234236163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health