Provider Demographics
NPI:1629204425
Name:MARTENSON, PAULA RAE (RN, BSN, PHN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:RAE
Last Name:MARTENSON
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W FIR AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1364
Mailing Address - Country:US
Mailing Address - Phone:218-385-5503
Mailing Address - Fax:218-385-3852
Practice Address - Street 1:118 N MAIN AVE
Practice Address - Street 2:BOX 99
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567
Practice Address - Country:US
Practice Address - Phone:218-385-5503
Practice Address - Fax:218-385-3852
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 133872-6163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health