Individual
MRS. JACQUELINE WILSON MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
538 WARRINER ST, REIDSVILLE, NC 27320-3053
(336) 348-6902
Mailing address
210 S VAN BUREN RD, EDEN, NC 27288-5025
(336) 577-2173
(336) 589-1320
Taxonomy
Speciality
Code
Description
License number
State
177F00000X
Lodging Provider
Primary
FCL-079-037
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7803777
—
NC
Enumeration date
01/23/2007
Last updated
07/08/2007
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