Provider Demographics
NPI:1225131485
Name:MARTIN, SYLVIA (RN)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MARTIN
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:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-0434
Mailing Address - Country:US
Mailing Address - Phone:573-546-7634
Mailing Address - Fax:
Practice Address - Street 1:128 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-1313
Practice Address - Country:US
Practice Address - Phone:573-546-3434
Practice Address - Fax:573-546-3006
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137272163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse