Healthcare Provider Details

I. General information

NPI: 1255483996
Provider Name (Legal Business Name): BARBARA ANNE MARTIN RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6065 STATE HIGHWAY 193
GEORGETOWN CA
95634-9623
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD SUITE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 530-333-2548
  • Fax:
Mailing address:
  • Phone: 855-771-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN209038
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN209038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: