Provider Demographics
NPI:1992897466
Name:ALSUP, MARTHA L (AAS, RN)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:L
Last Name:ALSUP
Suffix:
Gender:F
Credentials:AAS, RN
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Other - Credentials:
Mailing Address - Street 1:4500 STUART ST
Mailing Address - Street 2:MONCRIEF ARMY COMMUNITY HOSPITAL ATTN: MCXL-PQ
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29207-5700
Mailing Address - Country:US
Mailing Address - Phone:803-751-2618
Mailing Address - Fax:803-751-2689
Practice Address - Street 1:4500 STUART ST
Practice Address - Street 2:MONCRIEF ARMY COMMUNITY HOSPITAL ATTN: MCXL-PQ
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-751-2618
Practice Address - Fax:803-751-2689
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCR41,128163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health