Provider Demographics
NPI:1073225546
Name:EARHART, MARTHA MARIE
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARIE
Last Name:EARHART
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 1:3030 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-2518
Mailing Address - Country:US
Mailing Address - Phone:717-273-8000
Mailing Address - Fax:717-273-8244
Practice Address - Street 1:3030 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-2518
Practice Address - Country:US
Practice Address - Phone:717-273-8000
Practice Address - Fax:717-273-8244
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN106770L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse