Provider Demographics
NPI:1134779267
Name:GICHIA, MARTHA N (FNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:N
Last Name:GICHIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 E DEERFIELD RD APT 409
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4470
Mailing Address - Country:US
Mailing Address - Phone:989-400-6180
Mailing Address - Fax:
Practice Address - Street 1:1021 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-8740
Practice Address - Country:US
Practice Address - Phone:989-427-5320
Practice Address - Fax:989-427-8220
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily