Provider Demographics
NPI:1639147192
Name:MARTENS, NICOLE ANNE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANNE
Last Name:MARTENS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ANNE
Other - Last Name:KEELING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:17705 HUTCHINS DR
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4145
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:
Practice Address - Street 1:17705 HUTCHINS DR
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4145
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1236598363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1212418OtherMEDICA
MN123675OtherUCARE
MN05F16KEOtherBLUE CROSS
MNS78724Medicare UPIN