Provider Demographics
NPI:1265981591
Name:JAM, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:JAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14208 GRAND PRE,
Mailing Address - Street 2:APT. 303
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906
Mailing Address - Country:US
Mailing Address - Phone:301-221-3680
Mailing Address - Fax:
Practice Address - Street 1:14208 GRAND PRE RD
Practice Address - Street 2:APT. 303
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2810
Practice Address - Country:US
Practice Address - Phone:301-221-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1006220164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse