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General NPI Number Information
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NPI Number | 1629543640
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Entity Type | Individual
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Provider Name | JEANNETT MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 10/05/2018
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Last Update Date | 07/27/2021
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Provider Practice Location Address
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Address Line | 123 GIRARD BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2227
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Country | US
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Telephone | 505-726-4407
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Fax | 505-557-1941
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Provider Business Mailing Address
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Address Line | 123 GIRARD BLVD SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-2227
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Country | US
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Telephone | 505-264-9454
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Fax | 505-557-1941
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-54246
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License Number State | NM
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