Healthcare Provider Details

I. General information

NPI: 1164772877
Provider Name (Legal Business Name): NICHOLE ANN MARTY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE ANN PADJEN

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 STEIN BLVD
EAU CLAIRE WI
54701-6978
US

IV. Provider business mailing address

719 W HAMILTON AVE STE B
EAU CLAIRE WI
54701-6970
US

V. Phone/Fax

Practice location:
  • Phone: 715-830-0732
  • Fax:
Mailing address:
  • Phone: 715-552-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number166788-30
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5106-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: