MEDICARE: REBECCA DIANE MARTIN D.N.P,

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	363LF0000X	Family Nurse Practitioner	763825	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	763825	OTHER	TX	NURSING LICENSE

General Provider Information

NPI Number	:	1952689234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA DIANE MARTIN D.N.P,

Provider Business Mailing Address
First Line	:	2603 OAK LAWN AVE
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75219
Country	:	US
Telephone Number	:	214-396-4201
Fax Number	:	469-453-3335

Provider Business Practice Location Address
First Line	:	2603 OAK LAWN AVE
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75219-4021
Country	:	US
Telephone Number	:	214-396-4201
Fax Number	:	469-453-3335

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

Provider Enumeration Date	:	08/03/2011
Last Update Date	:	05/17/2012

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Directions to “ REBECCA DIANE MARTIN D.N.P,” Practice Location

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