Healthcare Provider Details

I. General information

NPI: 1619187739
Provider Name (Legal Business Name): MARTHA WAYMAN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 GRAND VIEW DR
HAMPTON VA
23664-1952
US

IV. Provider business mailing address

114 GRAND VIEW DR
HAMPTON VA
23664-1952
US

V. Phone/Fax

Practice location:
  • Phone: 757-850-3091
  • Fax: 757-850-5283
Mailing address:
  • Phone: 757-850-3091
  • Fax: 757-850-5283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number0024164520
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: