Provider Demographics
NPI:1598049785
Name:MARTELL, MAXIMINO (APRN, CCNS, RN, MSN)
Entity Type:Individual
Prefix:
First Name:MAXIMINO
Middle Name:
Last Name:MARTELL
Suffix:
Gender:M
Credentials:APRN, CCNS, RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54482
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4482
Mailing Address - Country:US
Mailing Address - Phone:985-871-5900
Mailing Address - Fax:
Practice Address - Street 1:80 GARDENIA DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9194
Practice Address - Country:US
Practice Address - Phone:985-871-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07268364SC0200X, 364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2330314Medicaid