Provider Demographics
NPI:1598573529
Name:MARTIN, CHRISTINE MERCEDES
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MERCEDES
Last Name:MARTIN
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:FRIEND
Mailing Address - State:NE
Mailing Address - Zip Code:68359-0086
Mailing Address - Country:US
Mailing Address - Phone:402-540-2241
Mailing Address - Fax:
Practice Address - Street 1:4920 S 65TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-1906
Practice Address - Country:US
Practice Address - Phone:402-405-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion