Provider Demographics
NPI:1427018472
Name:MARTINEZ, KIMBERLY A (CPNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CPNP
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Other - First Name:
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Mailing Address - Street 1:2910 CENTRE POINTE DRIVE
Mailing Address - Street 2:35 121A CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2327
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:347 NORTH SMITH AVENUE
Practice Address - Street 2:401 MIDWEST CHILDRENS RESOURCE CENTER
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-220-6750
Practice Address - Fax:651-220-6770
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR0980191363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48217Medicare UPIN