Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 101537 | CO |
NPI | 1023119658 |
---|---|
Provider Name | Maria Olivia Martinez |
First Address | Littleton, CO 80127-4946 |
Second Address | Lakewood, CO 80226-1086 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07101538 | (05) | CO |