Provider Demographics
NPI:1841463023
Name:JIMENEZ, MARTHA JUDITH (APRN, RN)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:JUDITH
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:APRN, RN
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:J
Other - Last Name:MAGALLANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:T-9 FORT MISSOULA
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7202
Mailing Address - Country:US
Mailing Address - Phone:406-532-8400
Mailing Address - Fax:406-543-9316
Practice Address - Street 1:209 N 10TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2357
Practice Address - Country:US
Practice Address - Phone:406-532-9101
Practice Address - Fax:406-363-4498
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35448363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health