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General NPI Number Information
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NPI Number | 1104194554
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Entity Type | Individual
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Provider Name | MRS. MARTHA JEAN ALDERSON
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Gender | Female
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | HWY 190 JORDAN RD. 100 ACE ST.
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City | POINT BLANK
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State | TX
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Zip | 77364
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Country | US
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Telephone | 936-377-4575
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 161
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City | POINT BLANK
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State | TX
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Zip | 77364
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Country | US
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Telephone | 936-377-4575
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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 | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 132612
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License Number State | TX
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