Basic Information
| Provider Information | |||||||||
| NPI: | 1851352504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINSEN | ||||||||
| FirstName: | WAYNE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1148 | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587021148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018376508 | ||||||||
| FaxNumber: | 7018581839 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 22ND AVE NW | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587030986 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018376508 | ||||||||
| FaxNumber: | 7018581839 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 7429 | ND | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 14320 | 05 | ND | MEDICAID | 28549 | 01 | ND | BCBSND | OTHER | 25985 | 01 | ND | ND BLUE CROSS BLUE SHIELD | OTHER |