Provider Demographics
NPI:1194236166
Name:MARTIN, ADDELYN (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:ADDELYN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 COLONIAL COMMONS CT STE 100
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2217
Mailing Address - Country:US
Mailing Address - Phone:803-286-9948
Mailing Address - Fax:
Practice Address - Street 1:1228 COLONIAL COMMONS CT STE 100
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2217
Practice Address - Country:US
Practice Address - Phone:803-286-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC235123163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health