Provider Demographics
NPI:1366646754
Name:DOXSTADER, MARTA ELAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:ELAINE
Last Name:DOXSTADER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 STATE ROUTE 274
Mailing Address - Street 2:
Mailing Address - City:REMSEN
Mailing Address - State:NY
Mailing Address - Zip Code:13438-4639
Mailing Address - Country:US
Mailing Address - Phone:315-865-6216
Mailing Address - Fax:
Practice Address - Street 1:STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:WOODGATE
Practice Address - State:NY
Practice Address - Zip Code:13494
Practice Address - Country:US
Practice Address - Phone:315-392-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181498-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse