Healthcare Provider Details

I. General information

NPI: 1205927084
Provider Name (Legal Business Name): JAMES JOHN MARTINEAU RN, MSN, FNP, NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 7TH AVE S EXPRESS CLINIC
PRINCETON MN
55371-4555
US

IV. Provider business mailing address

25162 134TH ST NW
ZIMMERMAN MN
55398-2103
US

V. Phone/Fax

Practice location:
  • Phone: 763-389-5207
  • Fax: 763-389-4138
Mailing address:
  • Phone: 763-360-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR 143375-7
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: