Healthcare Provider Details

I. General information

NPI: 1548124209
Provider Name (Legal Business Name): SHANNA MARTIN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 OXFORD ST N
AUBURN MA
01501-1525
US

IV. Provider business mailing address

279 OXFORD ST N
AUBURN MA
01501-1525
US

V. Phone/Fax

Practice location:
  • Phone: 774-578-5417
  • Fax:
Mailing address:
  • Phone: 774-578-5417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number838073
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: