Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 5010734 | NC |
NPI | 1023594884 |
---|---|
Provider Name | Kathryn Martin |
First Address | Charlotte, NC 28219-9305 |
Second Address | Charlotte, NC 28210-8538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2018 |
Last Update Date | 27/09/2021 |