Provider Demographics
NPI:1407493216
Name:MARTIN, LENAYA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LENAYA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:LENAYA
Other - Middle Name:MARIE
Other - Last Name:NAYDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:303-697-2583
Mailing Address - Fax:
Practice Address - Street 1:1950 REDTAIL HAWK DR
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517-9780
Practice Address - Country:US
Practice Address - Phone:303-698-2753
Practice Address - Fax:970-577-3464
Is Sole Proprietor?:No
Enumeration Date:2019-11-30
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995945-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000203885Medicaid