Individual
ALICIA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
58 CHATEAU DR, PETAL, MS 39465-4100
(678) 699-3489
Mailing address
58 CHATEAU DR, PETAL, MS 39465-4100
(678) 699-3489
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1036376
TX
Other
Enumeration date
10/23/2023
Last updated
10/23/2023
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