Healthcare Provider Details

I. General information

NPI: 1275958738
Provider Name (Legal Business Name): NELDA MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 02/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ 14300X WEST PAVILION
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

1 BARNES JEWISH HOSPITAL PLZ 14300X WEST PAVILION
SAINT LOUIS MO
63110-1003
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7951
  • Fax: 314-362-4302
Mailing address:
  • Phone: 314-362-7951
  • Fax: 314-362-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number096846
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: