Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2016025286 | MO |
NPI | 1003269374 |
---|---|
Provider Name | Sarah Z. Martin |
First Address | Saint Louis, MO 63127-1369 |
Second Address | Saint Louis, MO 63127-1368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2016 |
Last Update Date | 05/02/2021 |