MEDICARE: CAROLYN LOUISE BASS-MARTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1073245445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN LOUISE BASS-MARTE

Provider Business Mailing Address
First Line	:	6108 HARNESSMAKER CT APT 201
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4831
Country	:	US
Telephone Number	:	352-875-0659
Fax Number	:

Provider Business Practice Location Address
First Line	:	6108 HARNESSMAKER CT APT 201
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-4831
Country	:	US
Telephone Number	:	352-875-0659
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2022
Last Update Date	:	06/25/2022

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Directions to “ CAROLYN LOUISE BASS-MARTE ” Practice Location

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