Provider Demographics
NPI:1932320785
Name:REBMAN, MARTHA J (CRNA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:REBMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-1314
Mailing Address - Country:US
Mailing Address - Phone:615-865-5054
Mailing Address - Fax:
Practice Address - Street 1:809 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-1314
Practice Address - Country:US
Practice Address - Phone:615-865-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000029690163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3628689Medicare ID - Type Unspecified