Provider Demographics
NPI:1093880783
Name:MCCARTHY, MARTHA C (CNP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:C
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:MARTHA
Other - Middle Name:CLARE
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:801 ENCINO PL NE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2612
Mailing Address - Country:US
Mailing Address - Phone:505-242-7512
Mailing Address - Fax:505-242-0540
Practice Address - Street 1:801 ENCINO PL NE
Practice Address - Street 2:SUITE C2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2612
Practice Address - Country:US
Practice Address - Phone:505-242-7512
Practice Address - Fax:505-242-0540
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR37503163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG1875Medicaid