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General NPI Number Information
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NPI Number | 1164889010
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Entity Type | Individual
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Provider Name | TRACI MARTIN APRN, CNM
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Gender | Female
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Dates
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Enumeration Date | 01/23/2016
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Last Update Date | 02/16/2018
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Provider Practice Location Address
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Address Line | 8845 SIX PINES DR
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City | SHENANDOAH
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State | TX
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Zip | 77380-2675
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Country | US
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Telephone | 281-844-2814
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Fax |
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Provider Business Mailing Address
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Address Line | 3209 LOUIS RD
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City | CROSBY
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State | TX
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Zip | 77532-6406
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Country | US
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Telephone | 281-844-2814
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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 | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | AP130075
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License Number State | TX
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