Provider Demographics
NPI:1720138704
Name:DAVIDOWICZ, MARTHA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:
Last Name:DAVIDOWICZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 S TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5538
Mailing Address - Country:US
Mailing Address - Phone:480-820-1269
Mailing Address - Fax:602-248-0557
Practice Address - Street 1:651 W COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2718
Practice Address - Country:US
Practice Address - Phone:602-248-0550
Practice Address - Fax:602-248-0557
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN082184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ327313OtherAHCCCS PROVIDER NUMBER