Provider Demographics
NPI:1487027272
Name:MADRID, MARTHA (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:
Last Name:MADRID
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:J
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2625 E INDIAN SCHOOL RD UNIT 115
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6794
Mailing Address - Country:US
Mailing Address - Phone:406-860-8057
Mailing Address - Fax:
Practice Address - Street 1:2625 E INDIAN SCHOOL RD UNIT 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6794
Practice Address - Country:US
Practice Address - Phone:406-860-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT25249163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT25249OtherRN, MONTANA (COMPACT STATE)