Provider Demographics
NPI:1962783530
Name:CONNER, MARTA ROSA (BS)
Entity type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:ROSA
Last Name:CONNER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:ROSA
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:4750 VILLANOVA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3219
Mailing Address - Country:US
Mailing Address - Phone:907-479-6590
Mailing Address - Fax:
Practice Address - Street 1:3830 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7530
Practice Address - Country:US
Practice Address - Phone:907-455-1416
Practice Address - Fax:907-455-1487
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker