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General NPI Number Information
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NPI Number | 1194548206
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Entity Type | Organization
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Legal Business Name | MARBROOK WOUND REPAIR,PLLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 5540 CENTERVIEW DR STE 204
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City | RALEIGH
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State | NC
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Zip | 27606-8012
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Country | US
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Telephone | 276-340-2360
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Fax |
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Provider Business Mailing Address
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Address Line | 5540 CENTERVIEW DR STE 204
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City | RALEIGH
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State | NC
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Zip | 27606-8012
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARY MARGARET MARTIN
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Credential | FNP
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Telephone | 276-340-2360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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