Individual
JACQUELINE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7861 INDIAN RD, GLOUCESTER, VA 23061-5258
(757) 768-0141
Mailing address
4133 CEDAR BUSH RD, HAYES, VA 23072-2611
(757) 768-0141
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
VA
Other
Enumeration date
01/07/2021
Last updated
01/07/2021
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