Provider Demographics
NPI:1730303157
Name:STOLTENBERG, MARTIN A (APRN)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:STOLTENBERG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641130
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7130
Mailing Address - Country:US
Mailing Address - Phone:402-572-2907
Mailing Address - Fax:402-572-3544
Practice Address - Street 1:16909 LAKESIDE HILLS CT
Practice Address - Street 2:SUITE 400
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4664
Practice Address - Country:US
Practice Address - Phone:402-758-5850
Practice Address - Fax:402-758-5855
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NET-096688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health