MEDICARE: MS. PAULA B MARTIN C.N.S.

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	363L00000X	Nurse Practitioner	062550	MO
2	363L00000X	Nurse Practitioner	041-318181	IL
3	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	62550	MO

General Provider Information

NPI Number	:	1790897130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULA B MARTIN C.N.S.

Provider Business Mailing Address
First Line	:	8745 LITZSINGER DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2305
Country	:	US
Telephone Number	:	314-288-9720
Fax Number	:	314-961-4375

Provider Business Practice Location Address
First Line	:	8745 LITZSINGER DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-2305
Country	:	US
Telephone Number	:	314-288-9720
Fax Number	:	314-961-4375

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	01/02/2009

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