Individual
MALLORY WINNIE-MAE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPM, LM
Contact information
Practice address
10345 ALTA VISTA RD, FORT WORTH, TX 76244-6501
(817) 562-2828
Mailing address
10345 ALTA VISTA RD, FORT WORTH, TX 76244-6501
(817) 562-2828
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
99491
TX
Other
Enumeration date
07/25/2022
Last updated
07/25/2022
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