Provider Demographics
NPI:1568163095
Name:MARTIN, FREDDA I
Entity Type:Individual
Prefix:
First Name:FREDDA
Middle Name:I
Last Name: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 1:589 STEWARTS FERRY PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3414
Mailing Address - Country:US
Mailing Address - Phone:629-255-0516
Mailing Address - Fax:615-883-2451
Practice Address - Street 1:589 STEWARTS FERRY PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-3414
Practice Address - Country:US
Practice Address - Phone:629-255-0516
Practice Address - Fax:615-883-2451
Is Sole Proprietor?:No
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000054921164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse