Provider Demographics
NPI:1770837486
Name:MARTIN, BRETTE WILSON (RN, RNFA)
Entity type:Individual
Prefix:
First Name:BRETTE
Middle Name:WILSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, RNFA
Other - Prefix:
Other - First Name:BRETTE
Other - Middle Name:MARIE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, RNFA
Mailing Address - Street 1:5506 BRITE DR
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6931 ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5231
Practice Address - Country:US
Practice Address - Phone:301-968-3184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR198345163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant