Provider Demographics
NPI:1467741603
Name:LIBSTER, MARTHA M (PHD, RN, CNS, AHN-BC)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:M
Last Name:LIBSTER
Suffix:
Gender:F
Credentials:PHD, RN, CNS, AHN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27828-1693
Mailing Address - Country:US
Mailing Address - Phone:252-753-3039
Mailing Address - Fax:252-753-3059
Practice Address - Street 1:4304 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:NC
Practice Address - Zip Code:27828-1693
Practice Address - Country:US
Practice Address - Phone:252-753-3039
Practice Address - Fax:252-753-3059
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC210571364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health