Provider Demographics
NPI:1114580701
Name:NUGENT, MARTHA LEIGH (APRN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LEIGH
Last Name:NUGENT
Suffix:
Gender:F
Credentials:APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:ND
Mailing Address - Zip Code:58853-9998
Mailing Address - Country:US
Mailing Address - Phone:701-774-0461
Mailing Address - Fax:
Practice Address - Street 1:331 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ND
Practice Address - Zip Code:58853-9998
Practice Address - Country:US
Practice Address - Phone:701-774-0461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-149639363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology