Individual
MISS FONSHAY LATRICE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP-BC
Contact information
Practice address
999 18TH ST STE 3000, DENVER, CO 80202-2449
(888) 731-8994
Mailing address
15333 N PIMA RD STE 305, SCOTTSDALE, AZ 85260-2717
(888) 731-8994
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
5381716052
KS
363LG0600X
Gerontology Nurse Practitioner
70334
NM
363LG0600X
Gerontology Nurse Practitioner
705048
TX
363LG0600X
Gerontology Nurse Practitioner
860200
NV
363LG0600X
Gerontology Nurse Practitioner
AP115919
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206653214
—
TX
Enumeration date
09/30/2008
Last updated
10/02/2024
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