Provider Demographics
NPI:1962717264
Name:MARTEL, LYN (DOM)
Entity type:Individual
Prefix:
First Name:LYN
Middle Name:
Last Name:MARTEL
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 AVE. CRISTOBAL COLON
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-0000
Mailing Address - Country:US
Mailing Address - Phone:505-820-1817
Mailing Address - Fax:
Practice Address - Street 1:1707 AVENIDA CRISTOBAL COLON
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2305
Practice Address - Country:US
Practice Address - Phone:505-820-1817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM959171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist