Provider Demographics
NPI:1962275313
Name:MARTIN, CHRISTELE KIDIBU (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTELE
Middle Name:KIDIBU
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 KERY DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2817
Mailing Address - Country:US
Mailing Address - Phone:919-951-9514
Mailing Address - Fax:
Practice Address - Street 1:217 TURNER DR STE F
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5754
Practice Address - Country:US
Practice Address - Phone:336-342-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023085235207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine