MEDICARE: MS. HEIDI LYNNE MARTIN BSN

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	163W00000X	Registered Nurse	225855	MA

General Provider Information

NPI Number	:	1679755920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEIDI LYNNE MARTIN BSN

Provider Business Mailing Address
First Line	:	405 CHATHAM DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-8691
Country	:	US
Telephone Number	:	919-933-9345
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 CHATHAM DR
Second Line	:
City	:	CHAPEL HILL
State	:	NC
Zip	:	27516-8691
Country	:	US
Telephone Number	:	919-933-9345
Fax Number	:

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

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	11/28/2007

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