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General NPI Number Information
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NPI Number | 1780724666
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Entity Type | Individual
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Provider Name | MARTHA TETER CRNP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 359 FOREST AVE STE 203
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City | DAYTON
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State | OH
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Zip | 45405-4559
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Country | US
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Telephone | 937-226-7414
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Fax | 937-226-1682
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Provider Business Mailing Address
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Address Line | 3334 DARBYSHIRE DR
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City | BEAVERCREEK
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State | OH
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Zip | 45440-3672
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Country | US
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Telephone | 937-427-2027
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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 | NP-02174
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License Number State | OH
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