Healthcare Provider Details

I. General information

NPI: 1942429402
Provider Name (Legal Business Name): KATHLEEN K MARTA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 AUTUMN CHASE DR
ANNAPOLIS MD
21401-7257
US

IV. Provider business mailing address

223 AUTUMN CHASE DR
ANNAPOLIS MD
21401-7257
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-6838
  • Fax:
Mailing address:
  • Phone: 410-222-6838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR112808
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: