Provider Demographics
NPI:1649018946
Name:MARTIRE, ALEXIS CHARLENE (CNP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CHARLENE
Last Name:MARTIRE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1143
Mailing Address - Country:US
Mailing Address - Phone:218-259-2318
Mailing Address - Fax:
Practice Address - Street 1:1601 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-8648
Practice Address - Country:US
Practice Address - Phone:218-326-3401
Practice Address - Fax:218-999-1461
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily