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General NPI Number Information
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NPI Number | 1003599200
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Entity Type | Individual
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Provider Name | DIANE MARTIN RN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 8081 INNOVATION PARK DR. 5TH FLOOR
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 571-472-1646
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Fax | 571-472-7037
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Provider Business Mailing Address
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Address Line | 8081 INNOVATION PARK DR. 5TH FLOOR
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City | FAIRFAX
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State | VA
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Zip | 22031
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Country | US
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Telephone | 571-472-1646
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Fax | 571-472-7037
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | 0001229190
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163WX0800X
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Taxonomy Name | Orthopedic Registered Nurse
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License Number | 0001229190
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 163WU0100X
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Taxonomy Name | Urology Registered Nurse
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License Number | 0001229190
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License Number State | VA
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