Provider Demographics
NPI:1881037984
Name:SPEIGHT, MARTINA (NP)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:SPEIGHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:KELLY
Other - Last Name:SPEIGHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-725-2687
Mailing Address - Fax:650-725-6766
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:H2103
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-725-2687
Practice Address - Fax:650-725-6766
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner