Provider Demographics
NPI:1194921973
Name:MARTENS, MARK RICHARD (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:RICHARD
Last Name:MARTENS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 GREENWAY DR
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-4571
Mailing Address - Country:US
Mailing Address - Phone:763-229-5441
Mailing Address - Fax:
Practice Address - Street 1:310 GREENWAY DR
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-4571
Practice Address - Country:US
Practice Address - Phone:763-229-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR162211-5367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered