Provider Demographics
NPI:1609899806
Name:TIRYAKI, MARTHA (CNM)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:TIRYAKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 CEDAR SE #405
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-764-9535
Mailing Address - Fax:505-924-7336
Practice Address - Street 1:201 CEDAR SE #405
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-764-9535
Practice Address - Fax:505-924-7336
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM301176B00000X
NMR29952367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM94896Medicaid
P94192Medicare UPIN
NM348323403Medicare ID - Type Unspecified