Healthcare Provider Details

I. General information

NPI: 1548843089
Provider Name (Legal Business Name): DONNA MARIE MARTIN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W MAIN ST STE 303
SALISBURY MD
21801-4838
US

IV. Provider business mailing address

6685 MANADIER RD
EASTON MD
21601-4735
US

V. Phone/Fax

Practice location:
  • Phone: 410-800-2169
  • Fax:
Mailing address:
  • Phone: 410-476-7940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR083150
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: