Provider Demographics
NPI:1942476445
Name:HAVERLY, MARTHA JANE (MSN, APRN-BC, WHNP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JANE
Last Name:HAVERLY
Suffix:
Gender:F
Credentials:MSN, APRN-BC, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 OCALLAGHAN WAY
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905
Mailing Address - Country:US
Mailing Address - Phone:781-592-8675
Mailing Address - Fax:781-592-8695
Practice Address - Street 1:235 OCALLAGHAN WAY
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905
Practice Address - Country:US
Practice Address - Phone:781-592-8675
Practice Address - Fax:781-592-8695
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner