Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1101X | Ophthalmic Assistant | 156525 | NE |
NPI | 1699124586 |
---|---|
Provider Name | Mrs. Michelle Ann Martin |
First Address | Omaha, NE 68122-2268 |
Second Address | Omaha, NE 68122-2268 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2016 |
Last Update Date | 10/06/2016 |