Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN-62222 | NM |
NPI | 1013513779 |
---|---|
Provider Name | Ms. Mary Kathleen Martinez |
First Address | Albuquerque, NM 87111-1986 |
Second Address | Albuquerque, NM 87109-4314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2020 |
Last Update Date | 08/12/2020 |