Provider Demographics
NPI:1619183555
Name:MARTIN, JULIE BRYAN (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:BRYAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:VA
Mailing Address - Zip Code:24416-1312
Mailing Address - Country:US
Mailing Address - Phone:540-261-1410
Mailing Address - Fax:540-261-1409
Practice Address - Street 1:170 W 29TH ST
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:VA
Practice Address - Zip Code:24416-1312
Practice Address - Country:US
Practice Address - Phone:540-261-1410
Practice Address - Fax:540-261-1409
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000008176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife