Provider Demographics
NPI:1689896474
Name:PETERS, MARTIN LEWIS (MSN, RNP)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:LEWIS
Last Name:PETERS
Suffix:
Gender:M
Credentials:MSN, RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27361 SIERRA HWY
Mailing Address - Street 2:UNIT 314
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3053
Mailing Address - Country:US
Mailing Address - Phone:661-251-7359
Mailing Address - Fax:
Practice Address - Street 1:522 E BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4927
Practice Address - Country:US
Practice Address - Phone:818-548-6488
Practice Address - Fax:818-543-7305
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily