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NPI Code Detail

MEDICARE: MISS FONSHAY LATRICE MARTIN GNP-BC

MEDICARE: MISS FONSHAY LATRICE MARTIN GNP-BC
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
1363LG0600XGerontology Nurse Practitioner705048TX
2363LG0600XGerontology Nurse Practitioner860200NV
3363LG0600XGerontology Nurse PractitionerAP115919TX
4363LG0600XGerontology Nurse Practitioner70334NM
5363LG0600XGerontology Nurse Practitioner5381716052KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588814263
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS FONSHAY LATRICE MARTIN GNP-BC
Provider Business Mailing Address
First Line : 15333 N PIMA RD STE 305
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85260-2717
Country : US
Telephone Number : 888-731-8994
Fax Number :
Provider Business Practice Location Address
First Line : 999 18TH ST STE 3000
Second Line :
City : DENVER
State : CO
Zip : 80202-2449
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2008
Last Update Date : 10/02/2024

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Directions to “ MISS FONSHAY LATRICE MARTIN GNP-BC” Practice Location

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