Provider Demographics
NPI:1770196040
Name:DENSMORE, MARTHA (RN, LAC)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:DENSMORE
Suffix:
Gender:F
Credentials:RN, LAC
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:KHALSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, LAC
Mailing Address - Street 1:772 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-2405
Mailing Address - Country:US
Mailing Address - Phone:207-504-1524
Mailing Address - Fax:
Practice Address - Street 1:2445 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1932
Practice Address - Country:US
Practice Address - Phone:207-504-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME71500163W00000X
CA6902171100000X
MEAC686171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse