Healthcare Provider Details

I. General information

NPI: 1043949183
Provider Name (Legal Business Name): JAYME MARTELL DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 4TH AVE S
WISHEK ND
58495-7527
US

IV. Provider business mailing address

PO BOX 647
WISHEK ND
58495-0647
US

V. Phone/Fax

Practice location:
  • Phone: 701-452-2326
  • Fax:
Mailing address:
  • Phone: 701-452-2326
  • Fax: 701-452-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR40236
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: