Provider Demographics
NPI:1447624770
Name:MARTIN, CASSIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CASSIE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5967
Mailing Address - Country:US
Mailing Address - Phone:931-484-6196
Mailing Address - Fax:931-456-1047
Practice Address - Street 1:1503 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5967
Practice Address - Country:US
Practice Address - Phone:931-484-6196
Practice Address - Fax:931-456-1047
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN87016164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse