Provider Demographics
NPI:1568246619
Name:CUPP, MARTINA MICHELLE
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:MICHELLE
Last Name:CUPP
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 1:500 SHAFFER ST APT 301
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-1472
Mailing Address - Country:US
Mailing Address - Phone:304-789-9054
Mailing Address - Fax:
Practice Address - Street 1:500 SHAFFER ST APT 301
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-1472
Practice Address - Country:US
Practice Address - Phone:304-789-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant