Provider Demographics
NPI:1548568512
Name:MARTIN, DENISE JOAN (CNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:JOAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 N COUNCIL AVE
Mailing Address - Street 2:
Mailing Address - City:BLANCHARD
Mailing Address - State:OK
Mailing Address - Zip Code:73010-8038
Mailing Address - Country:US
Mailing Address - Phone:405-485-4701
Mailing Address - Fax:405-485-3747
Practice Address - Street 1:2002 N COUNCIL AVE
Practice Address - Street 2:
Practice Address - City:BLANCHARD
Practice Address - State:OK
Practice Address - Zip Code:73010-8038
Practice Address - Country:US
Practice Address - Phone:405-485-4701
Practice Address - Fax:405-485-3747
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-01717363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner