Healthcare Provider Details

I. General information

NPI: 1376769950
Provider Name (Legal Business Name): MARTHA MARTI COUNTS BRITTENHAM CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 BUENA VISTA DR SE
ALBUQUERQUE NM
87106-4023
US

IV. Provider business mailing address

PO BOX 1022
TIJERAS NM
87059-1022
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-3080
  • Fax: 505-224-3089
Mailing address:
  • Phone: 505-224-3080
  • Fax: 505-224-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR12012
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: