Basic Information
| Provider Information | |||||||||
| NPI: | 1023661683 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6305 BENT TREE DR NW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871203744 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054008615 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2145 CAJA DEL ORO GRANT RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 875073279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5054383195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2019 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 56928 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.