Healthcare Provider Details

I. General information

NPI: 1194236166
Provider Name (Legal Business Name): ADDELYN MARTIN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 COLONIAL COMMONS CT STE 100
LANCASTER SC
29720-2217
US

IV. Provider business mailing address

1228 COLONIAL COMMONS CT STE 100
LANCASTER SC
29720-2217
US

V. Phone/Fax

Practice location:
  • Phone: 803-286-9948
  • Fax:
Mailing address:
  • Phone: 803-286-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number235123
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: