Provider Demographics
NPI:1023114089
Name:MARTIN, MARY MARGARET (FNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NC
Mailing Address - Zip Code:27025-1913
Mailing Address - Country:US
Mailing Address - Phone:336-548-9618
Mailing Address - Fax:336-548-4877
Practice Address - Street 1:401 W DECATUR ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NC
Practice Address - Zip Code:27025-1913
Practice Address - Country:US
Practice Address - Phone:336-548-9618
Practice Address - Fax:336-548-4877
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1023114089OtherNC BLUE CROSS
NC2593171AOtherMEDICARE