Provider Demographics
NPI:1902576317
Name:MARTIN, URSULA N (RN)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 BISMARK ST STE A
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-1744
Mailing Address - Country:US
Mailing Address - Phone:901-628-6302
Mailing Address - Fax:
Practice Address - Street 1:1814 BISMARK ST STE A
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-1744
Practice Address - Country:US
Practice Address - Phone:901-628-6302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN192469163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health