Provider Demographics
NPI:1871891101
Name:ANDREW, MARTHA CAROL (LM, CPM)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:CAROL
Last Name:ANDREW
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:
Other - Last Name:ANDREW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, CPM
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:RANCHOS DE TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87557-1671
Mailing Address - Country:US
Mailing Address - Phone:575-751-7430
Mailing Address - Fax:
Practice Address - Street 1:188 MIRANDA CANYON ROAD
Practice Address - Street 2:
Practice Address - City:RANCHOS DE TAOS
Practice Address - State:NM
Practice Address - Zip Code:87557
Practice Address - Country:US
Practice Address - Phone:575-751-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM96368R175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay