Provider Demographics
NPI:1952689234
Name:MARTIN, REBECCA DIANE (DNP,)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DNP,
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2603 OAK LAWN AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219
Mailing Address - Country:US
Mailing Address - Phone:214-396-4201
Mailing Address - Fax:469-453-3335
Practice Address - Street 1:2603 OAK LAWN AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4021
Practice Address - Country:US
Practice Address - Phone:214-396-4201
Practice Address - Fax:469-453-3335
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2012-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX763825363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX763825OtherNURSING LICENSE