Provider Demographics
NPI:1720095243
Name:PRICE, MARTA S (AAPCNS)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:S
Last Name:PRICE
Suffix:
Gender:F
Credentials:AAPCNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 S CHURCH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-6769
Mailing Address - Country:US
Mailing Address - Phone:336-633-3190
Mailing Address - Fax:336-633-3189
Practice Address - Street 1:1130 S CHURCH ST
Practice Address - Street 2:SUITE C
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6769
Practice Address - Country:US
Practice Address - Phone:336-633-3190
Practice Address - Fax:336-633-3189
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0325476364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6004046Medicaid
NC2599151DMedicare ID - Type UnspecifiedAPRN,BC