Provider Demographics
NPI:1598741969
Name:FLEDDERMAN, MARTI (PNP, CNS, RN)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:
Last Name:FLEDDERMAN
Suffix:
Gender:F
Credentials:PNP, CNS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CARMELO LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-6555
Mailing Address - Country:US
Mailing Address - Phone:916-734-8031
Mailing Address - Fax:916-734-1656
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:RM. 4302 NURSING ADMIN.
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-8031
Practice Address - Fax:916-734-1656
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA332833363LP0200X, 364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Not Answered364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA04005Medicare UPIN