Provider Demographics
NPI:1871546077
Name:MARTIN, SANDRA D (CNM)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-5302
Mailing Address - Country:US
Mailing Address - Phone:409-747-0890
Mailing Address - Fax:409-772-0885
Practice Address - Street 1:701 E DAVIS ST
Practice Address - Street 2:STE. A.
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-3018
Practice Address - Country:US
Practice Address - Phone:936-525-2800
Practice Address - Fax:936-539-4668
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX435310367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR58647Medicare UPIN
TX80268MMedicare ID - Type Unspecified