Healthcare Provider Details

I. General information

NPI: 1770837486
Provider Name (Legal Business Name): BRETTE WILSON MARTIN RN, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BRETTE MARIE WILSON RN, RNFA

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 ARLINGTON RD
BETHESDA MD
20814-5231
US

IV. Provider business mailing address

5506 BRITE DR
BETHESDA MD
20817-6305
US

V. Phone/Fax

Practice location:
  • Phone: 301-968-3184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberR198345
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: