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General NPI Number Information
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NPI Number | 1689235343
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Entity Type | Individual
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Provider Name | ALYSE CHRISTINE MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 06/24/2019
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 2400 UNSER BLVD SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-3392
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Country | US
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Telephone | 55-596-1005
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Fax | 505-559-6101
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Provider Business Mailing Address
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Address Line | PO BOX 26666
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-559-6100
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 57114
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License Number State | NM
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