Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 95015446 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 95015446 | CA |
NPI | 1063091619 |
---|---|
Provider Name | Ms. Jenny Anne Martin |
First Address | Oakland, CA 94610-4608 |
Second Address | Oakland, CA 94612-3211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2021 |
Last Update Date | 02/04/2021 |