Provider Demographics
NPI:1992783005
Name:MARTINEZ, MARY ALLAN F (FNP)
Entity type:Individual
Prefix:
First Name:MARY ALLAN
Middle Name:F
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 CENTER DR
Mailing Address - Street 2:BLDG. 16
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4106
Mailing Address - Country:US
Mailing Address - Phone:757-466-3429
Mailing Address - Fax:757-466-1310
Practice Address - Street 1:6333 CENTER DR
Practice Address - Street 2:BLDG. 16
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4106
Practice Address - Country:US
Practice Address - Phone:757-466-3429
Practice Address - Fax:757-466-1310
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024083857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA25560NOtherSENTARA HEALTHCARE
P08840Medicare UPIN