Individual
MS. MARY DIANNE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
149 DRINKWATER RD, BAY ST LOUIS, MS 39520-1658
(228) 467-8775
(228) 467-8667
Mailing address
149 DRINKWATER RD, BAY ST LOUIS, MS 39520-1658
(228) 467-8775
(228) 467-8667
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP01498
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00126128
—
MS
Enumeration date
09/02/2006
Last updated
07/13/2007
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