Healthcare Provider Details

I. General information

NPI: 1851405245
Provider Name (Legal Business Name): MARTHA DYSART C.N.M. ; M.S.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 10/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 S FRENCH BROAD AVE
ASHEVILLE NC
28801-4364
US

IV. Provider business mailing address

390 S FRENCH BROAD AVE
ASHEVILLE NC
28801-4364
US

V. Phone/Fax

Practice location:
  • Phone: 828-378-0075
  • Fax: 828-378-0083
Mailing address:
  • Phone: 828-378-0075
  • Fax: 828-378-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number114501
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: