Provider Demographics
NPI:1629512314
Name:MARTIN, LYNN
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:
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 1:322 E STATESVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2594
Mailing Address - Country:US
Mailing Address - Phone:704-664-5363
Mailing Address - Fax:866-929-5355
Practice Address - Street 1:322 E STATESVILLE AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2594
Practice Address - Country:US
Practice Address - Phone:704-664-5363
Practice Address - Fax:866-929-5355
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4822163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCHC4822OtherHOME CARE AGENCY
NC343884Medicaid