Provider Demographics
NPI:1902638190
Name:MARTIN, TERESA ANTOINETTE (WHNP, CNM, RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANTOINETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:WHNP, CNM, RN
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 3170
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-3170
Mailing Address - Country:US
Mailing Address - Phone:919-360-2308
Mailing Address - Fax:
Practice Address - Street 1:11795 EDUCATION ST STE 222
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2469
Practice Address - Country:US
Practice Address - Phone:530-886-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95166095207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology