Provider Demographics
NPI:1508899469
Name:MARTIN, CYNTHIA R (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17251 ELK EST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35614-4459
Mailing Address - Country:US
Mailing Address - Phone:256-533-4626
Mailing Address - Fax:256-533-4710
Practice Address - Street 1:2325 PANSY ST SW
Practice Address - Street 2:SUITE E
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3834
Practice Address - Country:US
Practice Address - Phone:256-533-4626
Practice Address - Fax:256-533-4710
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL 1-093078363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891005730Medicaid
AL891005730Medicaid
AL051554254MARMedicare ID - Type Unspecified