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NPI Code Detail

MEDICARE: BONNIE JANE MARTIN FNP

MEDICARE: BONNIE JANE MARTIN FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN230731CA

General Provider Information

NPI Number : 1174520480
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE JANE MARTIN FNP
Provider Business Mailing Address
First Line : 7373 WEST LN
Second Line :
City : STOCKTON
State : CA
Zip : 95210-3377
Country : US
Telephone Number : 209-476-3928
Fax Number :
Provider Business Practice Location Address
First Line : 7373 WEST LN
Second Line :
City : STOCKTON
State : CA
Zip : 95210-3377
Country : US
Telephone Number : 209-476-3928
Fax Number : 209-476-3675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2005
Last Update Date : 07/09/2007

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Directions to “ BONNIE JANE MARTIN FNP” Practice Location

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