Provider Demographics
NPI:1164552915
Name:MARTINEZ, SHANNON R (RN)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 SHERIDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80003-2605
Mailing Address - Country:US
Mailing Address - Phone:303-657-6921
Mailing Address - Fax:
Practice Address - Street 1:7701 SHERIDAN BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-2605
Practice Address - Country:US
Practice Address - Phone:303-657-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO164534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
017394OtherKAISER-COMMERCIAL NUMBER