Provider Demographics
NPI:1467214114
Name:MCMILLION-MARTIN, CHARNICE
Entity Type:Individual
Prefix:
First Name:CHARNICE
Middle Name:
Last Name:MCMILLION-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 1:104 KERNS AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-1808
Mailing Address - Country:US
Mailing Address - Phone:716-465-6164
Mailing Address - Fax:
Practice Address - Street 1:104 KERNS AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-1808
Practice Address - Country:US
Practice Address - Phone:716-465-6164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula