Provider Demographics
NPI:1720022817
Name:MARTIN, STEVEN T (FNP)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:T
Last Name:MARTIN
Suffix:
Gender:M
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:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-0202
Mailing Address - Country:US
Mailing Address - Phone:901-757-2345
Mailing Address - Fax:901-757-9065
Practice Address - Street 1:2743 SUMMER OAKS DR
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2858
Practice Address - Country:US
Practice Address - Phone:901-371-0200
Practice Address - Fax:901-888-1146
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN116514164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4120365OtherBLUE CROSS
SD4120365OtherBLUE CROSS
TN3906493Medicare ID - Type Unspecified