Provider Demographics
NPI:1053972158
Name:MARTINEZ, KORI DAWN (APRN-FNP)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:DAWN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 YALE BLVD SE STE D3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4355
Mailing Address - Country:US
Mailing Address - Phone:505-842-4433
Mailing Address - Fax:505-842-4436
Practice Address - Street 1:2301 YALE BLVD SE STE D3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4355
Practice Address - Country:US
Practice Address - Phone:505-842-4433
Practice Address - Fax:505-842-4436
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM56734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily