Provider Demographics
NPI:1205860921
Name:MARTIN, NORA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 16TH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5150
Mailing Address - Country:US
Mailing Address - Phone:970-352-8526
Mailing Address - Fax:970-346-0409
Practice Address - Street 1:1802 16TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-5150
Practice Address - Country:US
Practice Address - Phone:970-352-8526
Practice Address - Fax:970-346-0409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CON/A103G00000X
CO1543103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07000250Medicaid
COR19402Medicare UPIN
COC60426Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER