Healthcare Provider Details

I. General information

NPI: 1861902157
Provider Name (Legal Business Name): HANNAH ELLEN MARTIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HOSPITAL COLORADO 13123 EAST 16TH AVENUE BOX 060
AURORA CO
80045-0600
US

IV. Provider business mailing address

PO BOX 60
AURORA CO
80040-0060
US

V. Phone/Fax

Practice location:
  • Phone: 720-777-4985
  • Fax: 720-777-7268
Mailing address:
  • Phone: 720-777-4985
  • Fax: 720-777-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0005098
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: