MEDICARE: MS. MARTHA WAYMAN WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse	0024164520	VA

General Provider Information

NPI Number	:	1619187739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARTHA WAYMAN WHNP

Provider Business Mailing Address
First Line	:	114 GRAND VIEW DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1952
Country	:	US
Telephone Number	:	757-850-3091
Fax Number	:	757-850-5283

Provider Business Practice Location Address
First Line	:	114 GRAND VIEW DR
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23664-1952
Country	:	US
Telephone Number	:	757-850-3091
Fax Number	:	757-850-5283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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