Provider Demographics
NPI:1255574851
Name:NORBURY, MARTHA JANE (LAC)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JANE
Last Name:NORBURY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:SAGE
Other - Middle Name:M
Other - Last Name:NORBURY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:202 NE CHIPMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2404
Mailing Address - Country:US
Mailing Address - Phone:913-406-8735
Mailing Address - Fax:816-554-4771
Practice Address - Street 1:202 NE CHIPMAN ROAD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2404
Practice Address - Country:US
Practice Address - Phone:913-406-8735
Practice Address - Fax:816-554-4771
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019018171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist