Provider Demographics
NPI:1053719161
Name:MARTSENYUK, ANNA (APRN, ACNS-BC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MARTSENYUK
Suffix:
Gender:F
Credentials:APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 W EVEREST LN STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6104
Mailing Address - Country:US
Mailing Address - Phone:208-505-4744
Mailing Address - Fax:844-402-0970
Practice Address - Street 1:2240 W EVEREST LN STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6104
Practice Address - Country:US
Practice Address - Phone:208-505-4744
Practice Address - Fax:844-402-0970
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCNS-73A208VP0000X, 364SA2200X
IDN-38361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No163W00000XNursing Service ProvidersRegistered Nurse