Provider Demographics
NPI:1902072739
Name:DOYLE, MARTHA LOUISE (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:LOUISE
Last Name:DOYLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3441
Mailing Address - Country:US
Mailing Address - Phone:707-823-0613
Mailing Address - Fax:
Practice Address - Street 1:369 TAFT ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3441
Practice Address - Country:US
Practice Address - Phone:707-823-0613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN289057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS09700Medicare PIN