Basic Information
Provider Information
NPI: 1144518218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARTIS
FirstName: FRANCINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1115 SE 164TH AVE
Address2: DEPT 358
City: VANCOUVER
State: WA
PostalCode: 986839324
CountryCode: US
TelephoneNumber: 3607382200
FaxNumber: 3607525686
Practice Location
Address1: 4545 CORDATA PKWY
Address2: SUITE 1A
City: BELLINGHAM
State: WA
PostalCode: 982267263
CountryCode: US
TelephoneNumber: 3607382200
FaxNumber: 3607525686
Other Information
ProviderEnumerationDate: 07/11/2011
LastUpdateDate: 08/04/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207Q00000XMD60459126WAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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