Provider Demographics
NPI:1336690429
Name:MARTIN, MIRIAH ELIZABETH
Entity Type:Individual
Prefix:
First Name:MIRIAH
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 STAYMAN RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8309
Mailing Address - Country:US
Mailing Address - Phone:540-588-9375
Mailing Address - Fax:
Practice Address - Street 1:60 SHILOH RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-0595
Practice Address - Country:US
Practice Address - Phone:423-636-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program