Provider Demographics
NPI:1083011274
Name:JOHNSON-MARTELL, CARMEN I (DNP)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:I
Last Name:JOHNSON-MARTELL
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:I
Other - Last Name:MARTELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:521 EATON ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3128
Mailing Address - Country:US
Mailing Address - Phone:860-922-2435
Mailing Address - Fax:
Practice Address - Street 1:2016 25TH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-5512
Practice Address - Country:US
Practice Address - Phone:757-915-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173716363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA20-8672011OtherMINUTE CLINIC