Provider Demographics
NPI:1952463788
Name:MARTIN, DORA E (MSN, WHCNP)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MSN, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6807 EMMETT F LOWRY EXPY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2546
Mailing Address - Country:US
Mailing Address - Phone:409-934-8687
Mailing Address - Fax:409-934-8689
Practice Address - Street 1:6807 EMMETT F LOWRY EXPY
Practice Address - Street 2:SUITE 308
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2546
Practice Address - Country:US
Practice Address - Phone:409-934-8687
Practice Address - Fax:409-934-8689
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX544593367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126655303Medicaid
TX126655303Medicaid
TXQ57454Medicare UPIN