Provider Demographics
NPI:1285098038
Name:MARTIN, ROSHEILA C (RN, CMSRN)
Entity type:Individual
Prefix:
First Name:ROSHEILA
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, CMSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18202 41ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-8735
Mailing Address - Country:US
Mailing Address - Phone:425-449-3760
Mailing Address - Fax:425-892-8565
Practice Address - Street 1:18202 41ST AVE SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-8735
Practice Address - Country:US
Practice Address - Phone:425-449-3760
Practice Address - Fax:425-892-8565
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60068496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse