Provider Demographics
NPI:1679384556
Name:MARTELL, MONA RAE
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:RAE
Last Name:MARTELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 14TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-2946
Mailing Address - Country:US
Mailing Address - Phone:701-269-5619
Mailing Address - Fax:
Practice Address - Street 1:214 NORTHLAND EST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-2776
Practice Address - Country:US
Practice Address - Phone:701-269-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker