Susan Vander Martin, RN

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

5620 E Beaver Ave
Wasilla, AK 99654-4633

Phone

(479) 774-2484

NPI assigned

Nov 20, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1124664594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5620 E BEAVER AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996544633",
            "telephone_number": "479-774-2484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5620 E BEAVER AVE",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "996544633",
            "telephone_number": "479-774-2484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER MARTIN",
        "first_name": "SUSAN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-20",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Grace Van Atta, PA-C, CNM
• Charles Hurst Van Ravenswaay
• Jessica D Van Wulven, PA-C
• Macy Vanbuskirk
• Tristan Shea Vandelac
• Joshua Vanderlooven
• Michaela Vanderlooven
• Dana Vandermartin
• Mandi Vandermartin
• Mathew Vandermartin

• Behavior Technician in Wasilla, AK
• Providers in Wasilla, AK by specialty
• Behavior Technician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.