Provider Demographics
NPI:1437561610
Name:MARTIN, GINA (LPN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:MARTIN
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 1:412 THEO MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-4836
Mailing Address - Country:US
Mailing Address - Phone:864-886-4515
Mailing Address - Fax:864-886-4516
Practice Address - Street 1:600 TOCCOA HWY
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1638
Practice Address - Country:US
Practice Address - Phone:864-886-4515
Practice Address - Fax:864-886-4516
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39214P164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse