Provider Demographics
NPI:1699425504
Name:MARTINEZ, KENDRA MANZONI (ARNP)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:MANZONI
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:MANZONI
Other - Last Name:CROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17408 HALLMAN RD NW
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8264
Mailing Address - Country:US
Mailing Address - Phone:253-820-0271
Mailing Address - Fax:
Practice Address - Street 1:1780 NW MYHRE RD STE 1220
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-698-4500
Practice Address - Fax:360-698-6960
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61436670363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2281232Medicaid