MEDICARE: URSULA N MARTIN RN

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	163WC1500X	Community Health Registered Nurse	192469	TN

General Provider Information

NPI Number	:	1902576317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	URSULA N MARTIN RN

Provider Business Mailing Address
First Line	:	1814 BISMARK ST STE A
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-1744
Country	:	US
Telephone Number	:	901-628-6302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 BISMARK ST STE A
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38109-1744
Country	:	US
Telephone Number	:	901-628-6302
Fax Number	:

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

Provider Enumeration Date	:	09/16/2021
Last Update Date	:	09/16/2021

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