Healthcare Provider Details

I. General information

NPI: 1306502679
Provider Name (Legal Business Name): MARTHA MEGAN STAIRES CPM, LLM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 S WASHINGTON AVE
FAYETTEVILLE AR
72701-6175
US

IV. Provider business mailing address

531 S WASHINGTON AVE
FAYETTEVILLE AR
72701-6175
US

V. Phone/Fax

Practice location:
  • Phone: 971-409-9494
  • Fax:
Mailing address:
  • Phone: 971-409-9494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number022021
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: