Provider Demographics
NPI:1881972107
Name:HART, MARTHA EDWARDS (NP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:EDWARDS
Last Name:HART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16681 GENERAL PULLER HWY
Practice Address - Street 2:
Practice Address - City:DELTAVILLE
Practice Address - State:VA
Practice Address - Zip Code:23043-2006
Practice Address - Country:US
Practice Address - Phone:804-776-8000
Practice Address - Fax:804-776-6211
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024059480363LN0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal