Provider Demographics
NPI:1801584255
Name:MARTIN, CHRISTINA CAROL
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CAROL
Last Name:MARTIN
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 1:123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3445
Mailing Address - Country:US
Mailing Address - Phone:580-377-8611
Mailing Address - Fax:
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-3445
Practice Address - Country:US
Practice Address - Phone:580-377-8611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist