Provider Demographics
NPI:1780937797
Name:MARTIN-STOMEL, ELAINE ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:ANN
Last Name:MARTIN-STOMEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:819 TOM MIX TRL
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6711
Mailing Address - Country:US
Mailing Address - Phone:928-445-1574
Mailing Address - Fax:928-445-1574
Practice Address - Street 1:804 AINSWORTH DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1624
Practice Address - Country:US
Practice Address - Phone:928-776-0601
Practice Address - Fax:928-776-0620
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP4702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLICENSE # AP4702OtherSTATE OF ARIZONA