Provider Demographics
NPI:1639110299
Name:MARTIN, CHRISTINA BASHNAN (NP)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:BASHNAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:302 MEDICAL PARK DR STE 211
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-5749
Mailing Address - Country:US
Mailing Address - Phone:843-549-9568
Mailing Address - Fax:843-549-1530
Practice Address - Street 1:400 CONSTANCE ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2710
Practice Address - Country:US
Practice Address - Phone:843-549-9568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2191363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0473Medicaid
SCP44029Medicare UPIN