Provider Demographics
NPI:1285326157
Name:BARBER, MARTINE DORENE
Entity type:Individual
Prefix:
First Name:MARTINE
Middle Name:DORENE
Last Name:BARBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5605 WASHINGTON AVE STE 8I
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4056
Mailing Address - Country:US
Mailing Address - Phone:262-955-2273
Mailing Address - Fax:
Practice Address - Street 1:5605 WASHINGTON AVE STE 8I
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4056
Practice Address - Country:US
Practice Address - Phone:262-955-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program