Healthcare Provider Details

I. General information

NPI: 1902313935
Provider Name (Legal Business Name): CARRIE A MARTINSON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARRIE ANN HALL

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date: 08/18/2024
Reactivation Date: 08/23/2024

III. Provider practice location address

3336 E CHANDLER HEIGHTS RD STE 123
GILBERT AZ
85298-4263
US

IV. Provider business mailing address

3336 E CHANDLER HEIGHTS RD STE 123
GILBERT AZ
85298-4263
US

V. Phone/Fax

Practice location:
  • Phone: 480-923-9094
  • Fax:
Mailing address:
  • Phone: 480-923-9094
  • Fax: 480-900-8657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number272149
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5283
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number272149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: