Provider Demographics
NPI:1871543108
Name:MARTIN, MINDY TEANN (ARNP)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:TEANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 51ST ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-2460
Mailing Address - Country:US
Mailing Address - Phone:319-294-1899
Mailing Address - Fax:319-294-1773
Practice Address - Street 1:1951 51ST ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2460
Practice Address - Country:US
Practice Address - Phone:319-294-1899
Practice Address - Fax:319-294-1773
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA095901363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2423764Medicaid
IA2423764Medicaid
IAI17377Medicare ID - Type Unspecified