Provider Demographics
NPI:1518166636
Name:MARTIN, DEBORAH ANN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325E KENNEDY MEMORIAL DR
Mailing Address - Street 2:MAINEGENERAL GASTROENTEROLOGY
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4531
Mailing Address - Country:US
Mailing Address - Phone:207-872-2424
Mailing Address - Fax:207-872-2099
Practice Address - Street 1:325E KENNEDY MEMORIAL DR
Practice Address - Street 2:MAINEGENERAL GASTROENTEROLOGY
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4531
Practice Address - Country:US
Practice Address - Phone:207-872-2424
Practice Address - Fax:207-872-2099
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER-027780363L00000X
MEAP081728363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432665499Medicaid
ME432665499Medicaid
ME000403901Medicare PIN
MA000403902Medicare PIN