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General NPI Number Information
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NPI Number | 1588814263
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Entity Type | Individual
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Provider Name | FONSHAY LATRICE MARTIN GNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 999 18TH ST STE 3000
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City | DENVER
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State | CO
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Zip | 80202-2449
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 15333 N PIMA RD STE 305
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2717
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Country | US
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Telephone | 888-731-8994
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 705048
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 860200
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP115919
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 70334
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License Number State | NM
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 5381716052
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License Number State | KS
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