Provider Demographics
NPI:1841347465
Name:PONNECH, MARTIN SHELDON (CRNFA)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:SHELDON
Last Name:PONNECH
Suffix:
Gender:M
Credentials:CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 RACINE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6607
Mailing Address - Country:US
Mailing Address - Phone:360-922-0202
Mailing Address - Fax:360-543-7919
Practice Address - Street 1:3319 RACINE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6607
Practice Address - Country:US
Practice Address - Phone:360-922-0202
Practice Address - Fax:360-543-7919
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00102728163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9633934Medicaid
WA47092OtherL&I PROVIDER NUMBER
WA24807200OtherGROUP HEALTH PROVIDER NUM