Healthcare Provider Details

I. General information

NPI: 1720813587
Provider Name (Legal Business Name): SONGHUI MARTIN RN, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 N DOLAN CT
PRESCOTT VALLEY AZ
86314-6753
US

IV. Provider business mailing address

5420 N DOLAN CT
PRESCOTT VALLEY AZ
86314-6753
US

V. Phone/Fax

Practice location:
  • Phone: 626-464-4379
  • Fax:
Mailing address:
  • Phone: 626-464-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number729174
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002239-PA
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number255309
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: