MEDICARE: JENNIFER MARTHERS CRNP

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
1	363L00000X	Nurse Practitioner	SP018425	PA
2	363LA2200X	Adult Health Nurse Practitioner	89463	NM
3	363LG0600X	Gerontology Nurse Practitioner	SP018425	PA

General Provider Information

NPI Number	:	1447768809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARTHERS CRNP

Provider Business Mailing Address
First Line	:	PO BOX 26666
Second Line	:	PHS PROVIDER ENROLLMENT
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87125-6666
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4588 PARADISE BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114
Country	:	US
Telephone Number	:	505-923-2070
Fax Number	:	505-998-1710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	06/23/2026

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