Provider Demographics
NPI:1205195773
Name:GARCIA, MARTHA LOUISA (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LOUISA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043-0067
Mailing Address - Country:US
Mailing Address - Phone:406-477-4551
Mailing Address - Fax:406-477-3830
Practice Address - Street 1:100 N CHEYENNE AVENUE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043-0067
Practice Address - Country:US
Practice Address - Phone:406-477-4551
Practice Address - Fax:406-477-3830
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT39805163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse