Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 3010370 | KY |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 28143085A | IN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3010370 | KY |
NPI | 1003027228 |
---|---|
Provider Name | Mr. Sean F Martindale |
First Address | Louisville, KY 40295-0244 |
Second Address | Louisville, KY 40212-1033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2007 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100424600 | (05) | KY |