Healthcare Provider Details

I. General information

NPI: 1023661683
Provider Name (Legal Business Name): ADRIENNE ANN MARTINEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 CAJA DEL ORO GRANT RD
SANTA FE NM
87507-3279
US

IV. Provider business mailing address

6305 BENT TREE DR NW
ALBUQUERQUE NM
87120-3744
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-3195
  • Fax:
Mailing address:
  • Phone: 505-400-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number56928
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: