Provider Demographics
NPI:1568810646
Name:ROBERT, MARTHA (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:ROBERT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FEENER CIR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3407
Mailing Address - Country:US
Mailing Address - Phone:617-763-4987
Mailing Address - Fax:
Practice Address - Street 1:7 FEENER CIR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3407
Practice Address - Country:US
Practice Address - Phone:617-763-4987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN267212163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical