Provider Demographics
NPI:1386010007
Name:MARTIN, MARY (CNS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 OLD HUNTSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6013
Mailing Address - Country:US
Mailing Address - Phone:931-625-5195
Mailing Address - Fax:
Practice Address - Street 1:85 OLD HUNTSVILLE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-6013
Practice Address - Country:US
Practice Address - Phone:931-625-5195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN138544163W00000X
AL1-142250163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse