Provider Demographics
NPI:1710221452
Name:MARTIN, SONJA JOANNE (RN)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:JOANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:JOANNE
Other - Last Name:MIEARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:928 PLAYER LN
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-3483
Mailing Address - Country:US
Mailing Address - Phone:805-903-3052
Mailing Address - Fax:
Practice Address - Street 1:928 PLAYER LN
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3483
Practice Address - Country:US
Practice Address - Phone:805-903-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706054163WC0400X, 163WG0000X, 163WH0200X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA706054OtherRN LICENSE