Provider Demographics
NPI:1952348922
Name:FRANCIS, MARTHA EILEEN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:EILEEN
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:EILEEN
Other - Last Name:ALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 64620
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4620
Mailing Address - Country:US
Mailing Address - Phone:410-328-3037
Mailing Address - Fax:410-328-3040
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:GUDELSKY BASEMENT
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3037
Practice Address - Fax:410-328-3040
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR172718OtherSTATE LICENSE NUMBER
MDQ24759Medicare UPIN
MDR172718OtherSTATE LICENSE NUMBER