1780937797 NPI number — MRS. ELAINE ANN MARTIN-STOMEL FNP

Table of content: MRS. ELAINE ANN MARTIN-STOMEL FNP (NPI 1780937797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780937797 NPI number — MRS. ELAINE ANN MARTIN-STOMEL FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN-STOMEL
Provider First Name:
ELAINE
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780937797
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 TOM MIX TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86301-6711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-445-1574
Provider Business Mailing Address Fax Number:
928-445-1574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
804 AINSWORTH DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PRESCOTT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86301-1624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-776-0601
Provider Business Practice Location Address Fax Number:
928-776-0620
Provider Enumeration Date:
10/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP4702 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LICENSE # AP4702 . This is a "STATE OF ARIZONA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com