Provider Demographics
NPI:1770953804
Name:MARTIN, CHRISTIN ALISE (CPNP)
Entity type:Individual
Prefix:
First Name:CHRISTIN
Middle Name:ALISE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10807 FALLS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4591
Mailing Address - Country:US
Mailing Address - Phone:337-513-2983
Mailing Address - Fax:
Practice Address - Street 1:10807 FALLS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4591
Practice Address - Country:US
Practice Address - Phone:337-513-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR218179363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics