Provider Demographics
NPI:1144777640
Name:WARD, MARTHA L (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:L
Last Name:WARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MADDEN AVE.
Mailing Address - Street 2:
Mailing Address - City:BRAGGS
Mailing Address - State:OK
Mailing Address - Zip Code:74423
Mailing Address - Country:US
Mailing Address - Phone:918-487-5265
Mailing Address - Fax:918-487-2012
Practice Address - Street 1:300 MADDEN AVE.
Practice Address - Street 2:
Practice Address - City:BRAGGS
Practice Address - State:OK
Practice Address - Zip Code:74423
Practice Address - Country:US
Practice Address - Phone:918-487-5265
Practice Address - Fax:918-487-2012
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0024159163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool