Healthcare Provider Details

I. General information

NPI: 1831439504
Provider Name (Legal Business Name): MARTHA ABBOTT CREED CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE VA PALO ALTO
PALO ALTO CA
94304
US

IV. Provider business mailing address

4050 N STOWELL AVE
MILWAUKEE WI
53211
US

V. Phone/Fax

Practice location:
  • Phone: 650-852-3274
  • Fax:
Mailing address:
  • Phone: 414-350-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number364SP0809X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: