Provider Demographics
NPI:1164511689
Name:MARTIN, PATRICIA L (CNM)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-3408
Mailing Address - Country:US
Mailing Address - Phone:603-742-2424
Mailing Address - Fax:603-742-1763
Practice Address - Street 1:700 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3408
Practice Address - Country:US
Practice Address - Phone:603-742-2424
Practice Address - Fax:603-742-1763
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH014379-23-01367A00000X
NH014379-23363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010195Medicaid
RE4333Medicare ID - Type Unspecified
P04879Medicare UPIN