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NPI Code Detail

MEDICARE: MALLORY WINNIE-MAE MARTIN CPM, LM

MEDICARE: MALLORY WINNIE-MAE MARTIN CPM, LM
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
1176B00000XMidwife99491TX

General Provider Information

NPI Number : 1598491359
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY WINNIE-MAE MARTIN CPM, LM
Provider Business Mailing Address
First Line : 10345 ALTA VISTA RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6501
Country : US
Telephone Number : 817-562-2828
Fax Number :
Provider Business Practice Location Address
First Line : 10345 ALTA VISTA RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-6501
Country : US
Telephone Number : 817-562-2828
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2022
Last Update Date : 07/25/2022

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Directions to “ MALLORY WINNIE-MAE MARTIN CPM, LM” Practice Location

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