Basic Information
| Provider Information | |||||||||
| NPI: | 1073253225 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | F | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6025 SPORTS VILLAGE RD | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750333505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146879374 | ||||||||
| FaxNumber: | 2146879385 | ||||||||
| Practice Location | |||||||||
| Address1: | 6025 SPORTS VILLAGE RD | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750333505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146879374 | ||||||||
| FaxNumber: | 2146879385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2022 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-21-176127 | AR | Y |
No ID Information.