Provider Demographics
NPI:1184707077
Name:DROHOBYCZER, MARTHA MARIE (CNM)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:MARIE
Last Name:DROHOBYCZER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 S JONES BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5648
Mailing Address - Country:US
Mailing Address - Phone:702-365-9929
Mailing Address - Fax:702-365-9931
Practice Address - Street 1:2810 S JONES BLVD
Practice Address - Street 2:SUITE #3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5648
Practice Address - Country:US
Practice Address - Phone:702-365-9929
Practice Address - Fax:702-365-9931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN538364SP0809X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Not Answered367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV31557Medicare ID - Type Unspecified
NVS16735Medicare UPIN