Provider Demographics
NPI:1679755920
Name:MARTIN, HEIDI LYNNE (BSN)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:LYNNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-8691
Mailing Address - Country:US
Mailing Address - Phone:919-933-9345
Mailing Address - Fax:
Practice Address - Street 1:405 CHATHAM DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-8691
Practice Address - Country:US
Practice Address - Phone:919-933-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA225855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse