Provider Demographics
NPI:1699538975
Name:MARTIN CHICOINE, COLLEEN ANNE (WHNP/CNM)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:MARTIN CHICOINE
Suffix:
Gender:F
Credentials:WHNP/CNM
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:499 WASHBURN DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-2851
Mailing Address - Country:US
Mailing Address - Phone:510-499-3241
Mailing Address - Fax:
Practice Address - Street 1:499 WASHBURN DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-2851
Practice Address - Country:US
Practice Address - Phone:510-499-3241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028227363LW0102X
CA236411367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health