Healthcare Provider Details

I. General information

NPI: 1669150058
Provider Name (Legal Business Name): CATHERINE V MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3128 GRACELAND CIR
PINEVILLE NC
28134-7480
US

IV. Provider business mailing address

3128 GRACELAND CIR
PINEVILLE NC
28134-7480
US

V. Phone/Fax

Practice location:
  • Phone: 704-605-6435
  • Fax:
Mailing address:
  • Phone: 704-605-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number20150879
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: