Provider Demographics
NPI:1053071613
Name:VAN DRIEL, MARTHA ELIZABETH (FNP-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ELIZABETH
Last Name:VAN DRIEL
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 1:7350 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-6427
Mailing Address - Country:US
Mailing Address - Phone:520-771-8389
Mailing Address - Fax:520-771-9339
Practice Address - Street 1:7350 E 22ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6427
Practice Address - Country:US
Practice Address - Phone:520-771-8389
Practice Address - Fax:520-771-9339
Is Sole Proprietor?:No
Enumeration Date:2021-12-23
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208030163WC1500X
AZ301086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health