Provider Demographics
NPI:1205927084
Name:MARTINEAU, JAMES JOHN (RN, MSN, FNP, NP-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:MARTINEAU
Suffix:
Gender:M
Credentials:RN, MSN, FNP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25162 134TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ZIMMERMAN
Mailing Address - State:MN
Mailing Address - Zip Code:55398-2103
Mailing Address - Country:US
Mailing Address - Phone:763-360-7070
Mailing Address - Fax:
Practice Address - Street 1:1100 7TH AVE S
Practice Address - Street 2:EXPRESS CLINIC
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-4555
Practice Address - Country:US
Practice Address - Phone:763-389-5207
Practice Address - Fax:763-389-4138
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 143375-7363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN41-1952112Medicaid