Provider Demographics
NPI:1861919516
Name:DUSH, MARTI ANNE
Entity type:Individual
Prefix:
First Name:MARTI
Middle Name:ANNE
Last Name:DUSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7723 COLONEL GLENN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-7503
Mailing Address - Country:US
Mailing Address - Phone:501-280-9195
Mailing Address - Fax:501-664-2488
Practice Address - Street 1:7723 COLONEL GLENN RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-7503
Practice Address - Country:US
Practice Address - Phone:501-280-9195
Practice Address - Fax:501-664-2488
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR178964795Medicaid