Provider Demographics
NPI:1295296481
Name:MARTINEZ-BAKER, ALYSSA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:MARTINEZ-BAKER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1180 N MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4932
Mailing Address - Country:US
Mailing Address - Phone:419-315-1225
Mailing Address - Fax:
Practice Address - Street 1:1180 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1388
Practice Address - Country:US
Practice Address - Phone:419-315-1225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.396883163W00000X
OHF06220981363LP2300X
OHAPRN.CNP0031688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care