Provider Demographics
NPI:1437789658
Name:PEDERSEN, MARTHA CAREY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:CAREY
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:MARTHA
Other - Middle Name:CAREY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 LYTTON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:530 LYTTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-5759
Practice Address - Country:US
Practice Address - Phone:415-663-5584
Practice Address - Fax:844-640-3975
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995159-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily