Provider Demographics
NPI:1477088011
Name:MARTINEZ, NOELLE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:MARIE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:MARIE
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:510-869-8865
Mailing Address - Fax:510-869-6271
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-5163
Practice Address - Fax:650-723-7680
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95005875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95005875OtherSTATE MEDICAL LICENSE
CAF02170489OtherBOARD CERTIFICATION
CANPF95005875OtherSTATE MEDICAL LICENSE
CARN790855OtherSTATE MEDICAL LICENSE