Provider Demographics
NPI:1326396276
Name:MARTIN, GINA MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:GINA
Middle Name:MARIE
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 1:21390 W GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-5426
Mailing Address - Country:US
Mailing Address - Phone:262-271-4775
Mailing Address - Fax:
Practice Address - Street 1:21390 W GREENHILL RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5426
Practice Address - Country:US
Practice Address - Phone:262-271-4775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI137705-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse