Individual
IRENE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
120 5TH AVENUE, MCCOMB, MS 39648
(601) 249-0013
(601) 249-0592
Mailing address
1014 CAUSEY ROAD, MCCOMB, MS 39648
(601) 876-4926
(601) 876-0980
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R736598
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0111641
—
MS
Enumeration date
04/30/2007
Last updated
07/06/2012
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