Provider Demographics
NPI:1790313419
Name:MARTHINI, SHELLIE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:SHELLIE
Middle Name:
Last Name:MARTHINI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 BEANE RD
Mailing Address - Street 2:
Mailing Address - City:MOXEE
Mailing Address - State:WA
Mailing Address - Zip Code:98936-9750
Mailing Address - Country:US
Mailing Address - Phone:509-948-2252
Mailing Address - Fax:
Practice Address - Street 1:560 GAGE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9531
Practice Address - Country:US
Practice Address - Phone:509-942-3135
Practice Address - Fax:509-627-1188
Is Sole Proprietor?:No
Enumeration Date:2020-03-29
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61059985363LA2200X, 363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA169.940-00OtherL&I