BRENT A MARTIN (NPI# 1265940365) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265940365 |
| Entity Type | Individual |
| Full Name | BRENT A MARTIN |
| Credential | APNP |
| Practice Address |
2809 N Park Drive Ln Appleton WI 54911-1603 |
| Mailing Address |
122 E College Ave Appleton WI 54911-5794 |
| Practice Telephone | 9203804999 |
| Practice Fax Number | 9203804961 |
| Mailing Telephone | 9209963264 |
| Mailing Fax Number | 9208305970 |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2018-03-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 201119 | WI | Nursing Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
8290 | WI | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447412580 | Brent Erickson Martin | Dentist | 1721 E Lincoln Ave, Sunnyside, WA 98944-2478 | 2008-06-30 |
| 1417081316 | Brent Curtis Martin | Physician Assistant | 10 Medical Center Blvd Ste C, Lufkin, TX 75904-3163 | 2007-03-15 |
| 1891743811 | Brent Leonard Martin | Dentist | 8380 City Centre Dr, Suite 120, Woodbury, MN 55125-5304 | 2006-05-04 |
| 1417560046 | Brent Martin | Pharmacist | 211 W College St, Colquitt, GA 39837-3403 | 2020-08-24 |
| 1972990869 | Brent Charles Martin | Dermatology | 17271 Brookhurst St, Fountain Valley, CA 92708-3701 | 2015-04-19 |
| 1538336615 | Brent D Martin | Dentist | 3551 Roger Brooke Dr, Quality Services/7th Floor Attn: Mche-zqq, Jbsa Ft Sam Houston, TX 78234-4504 | 2008-05-08 |
| 1427109875 | Brent Martin | Dentist | 1216 Farmington Ave, Suite 201, West Hartford, CT 06107-2672 | 2007-01-14 |
| Street Address |
2809 N PARK DRIVE LN |
| City | APPLETON |
| State | WI |
| Zip Code | 54911-1603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205897279 | Laura Ann Madson | Physician Assistant | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2006-03-30 |
| 1427421783 | Jessica E Radtke | Nurse Practitioner | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2015-11-09 |
| 1083003826 | Michelle A Wilke | Counselor | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2015-01-16 |
| 1336544972 | Darya Quandt | Counselor | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2014-10-24 |
| 1972936789 | Stephanie R Smith | Physical Therapist | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2013-08-15 |
| 1649588914 | Melissa N Miller | Physician Assistant | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2010-09-20 |
| 1669646071 | Dia M Welch | Nurse Practitioner | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2008-04-16 |
| 1962595249 | Bridget S Huenink | Nurse Practitioner | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2006-10-01 |
| 1508959883 | Bonnie L Nickasch | Nurse Practitioner | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2006-10-01 |
| 1376656959 | Thedacare, Incorporated | Family Medicine | 2809 N Park Drive Ln, Appleton, WI 54911-1603 | 2006-08-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912545633 | Brotherly Love, LLC | Day Training, Developmentally Disabled Services | 1513 E Frances St, Appleton, WI 54911 | 2019-12-12 |
| 1952952129 | Eagle Point Senior Living Inc | Assisted Living Facility | 995 East John Street, Appleton, WI 54911 | 2019-09-27 |
| 1619524766 | University Rx LLC | Pharmacy | 133 E College Ave, Appleton, WI 54911 | 2019-08-23 |
| 1174080063 | Shayla Russell | Counselor | Outagamie County Health and Human Services, 320 S. Walnut St., Appleton, WI 54911 | 2019-02-27 |
| 1871086645 | Megan Kilsdonk | Health Educator | 1604 N Meade St, Appleton, WI 54911 | 2018-06-07 |
| 1871085480 | Tanya Lynn Vickery | Social Worker | 410 S. Elm St., Appleton, WI 54911 | 2018-05-31 |
| 1013407501 | Teri G Metropulos | Counselor | 229 S. Morrison, Appleton, WI 54911 | 2018-05-10 |
| 1093211211 | Bonnie Anne Korytkowski | Student in an Organized Health Care Education/Training Program | 229 S. Morrison Street, Appleton, WI 54911 | 2018-04-05 |
| 1639673940 | Brett Follett | Psychologist | 401 S. Elm St., Appleton, WI 54911 | 2018-03-21 |
| 1700202892 | Brian Withrow | Counselor | 607 West 7th St., Appleton, WI 54911 | 2014-03-13 |
| Find all providers in zip 54911 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518519982 | Jacqueline Karlin | Nurse Practitioner | 2535 Northern Rd Ste D, Appleton, WI 54914-8753 | 2019-07-15 |
| 1700351301 | Jessica Friday | Nurse Practitioner | 3815 Stoney Creek Ct, Appleton, WI 54913-7953 | 2018-10-10 |
| 1871076273 | Alecia Raschke | Nurse Practitioner | 3232 N Ballard Rd Ste 100, Appleton, WI 54911-8804 | 2018-09-11 |
| 1386155216 | Mh Health Care Services, PC | Nurse Practitioner | 2175 S Memorial Dr, Appleton, WI 54915-1435 | 2017-10-18 |
| 1699184580 | Michelle Becker | Nurse Practitioner | 4435 West Lawrence St., Appleton, WI 54914 | 2014-08-05 |
| 1649693326 | Katlyn Sue Hansen | Nurse Practitioner | 2700 E Enterprise Ave Ste B, Appleton, WI 54913-7656 | 2014-01-30 |
| 1104104892 | Carissa Jo Meyer | Nurse Practitioner | 277 N Altenhofen Dr, Appleton, WI 54913-8401 | 2011-07-28 |
| 1184882334 | Jana Lynn Esden | Nurse Practitioner | 913 S West Ave, Appleton, WI 54915-2394 | 2008-05-23 |
| 1659390037 | Linda Jean Middleton | Nurse Practitioner | 10tri Park Way, Appleton, WI 54914 | 2006-07-18 |
| 1902413081 | Miranda Wendricks | Nurse Practitioner | 2500 E Capitol Dr, Appleton, WI 54911-8735 | 2020-09-23 |
| Find all providers in APPLETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.