Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99038 | TX |
NPI | 1114120904 |
---|---|
Provider Name | Ms. Christy R. Martin |
First Address | Fort Worth, TX 76116-0734 |
Second Address | Hurst, TX 76054-3190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2007 |
Last Update Date | 08/07/2007 |