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General NPI Number Information
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NPI Number | 1073236774
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Entity Type | Individual
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Provider Name | SHELLEY DEANNA MARTIN CRNP- FAMILY
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 7450 ALBERT RD
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City | BRANDYWINE
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State | MD
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Zip | 20613-3035
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Country | US
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Telephone | 301-599-0460
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Fax |
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Provider Business Mailing Address
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Address Line | 11214 MATTAPONI RD
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City | UPPER MARLBORO
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State | MD
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Zip | 20772-8211
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Country | US
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Telephone | 703-477-9031
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R139536
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License Number State | MD
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