Provider Demographics
NPI:1063241271
Name:LEBBIE, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:LEBBIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7355 E FURNACE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7060
Mailing Address - Country:US
Mailing Address - Phone:410-766-3460
Mailing Address - Fax:
Practice Address - Street 1:7355 E FURNACE BRANCH RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-7060
Practice Address - Country:US
Practice Address - Phone:410-766-3460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR222450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily