Luella Pauline Martin, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

LP039599 Issued in AZ

Practice address

11800 W Thompson Ranch Rd
El Mirage, AZ 85335-3208

Phone

(623) 523-8404

Fax

(623) 523-8411

NPI assigned

Mar 5, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851420657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17061 W HALIFAX LN",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853746887",
            "telephone_number": "623-266-3028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 W THOMPSON RANCH RD",
            "city": "EL MIRAGE",
            "state": "AZ",
            "postal_code": "853353208",
            "telephone_number": "623-523-8404",
            "fax_number": "623-523-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "LUELLA",
        "middle_name": "PAULINE",
        "name_prefix": "Mrs.",
        "credential": "LPN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "AZ",
            "license": "LP039599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "897043",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Licensed Practical Nurse in El Mirage, AZ
• Providers in El Mirage, AZ by specialty
• Licensed Practical Nurse in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.