Healthcare Provider Details

I. General information

NPI: 1811964927
Provider Name (Legal Business Name): TERESA ANN MARTINEZ ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 AGENCY SQUARE LOOP
WELLPINIT WA
99040-0357
US

IV. Provider business mailing address

PO BOX 357
WELLPINIT WA
99040-0357
US

V. Phone/Fax

Practice location:
  • Phone: 509-258-4517
  • Fax: 509-258-4456
Mailing address:
  • Phone: 509-258-4517
  • Fax: 509-258-4456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: