Provider Demographics
NPI:1619459021
Name:TATUM, MARTHA ANNE (RN, BSN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
Last Name:TATUM
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4311 MAGEE DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-8427
Mailing Address - Country:US
Mailing Address - Phone:870-648-4027
Mailing Address - Fax:
Practice Address - Street 1:4311 MAGEE DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-8427
Practice Address - Country:US
Practice Address - Phone:870-648-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR054158163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health