Individual
MILDRED LOUISE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,MSN,MA,PMHNP-BC
Contact information
Practice address
164 WACCAMAW MEDICAL PARK DR, CONROY, SC 29526
(843) 347-4888
(843) 347-4102
Mailing address
164 WACCAMAW MEDICAL PARK DR, CONWAY, SC 29526-8903
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
000720
NV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
17888APRN
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
327877
—
SC
Enumeration date
04/27/2006
Last updated
01/31/2014
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