Provider Demographics
NPI:1538213236
Name:NANDA, LETICIA VEHEMENTE MARTINEZ (MS, CRNP)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:VEHEMENTE MARTINEZ
Last Name:NANDA
Suffix:
Gender:F
Credentials:MS, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4915 WILLSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21206-4329
Mailing Address - Country:US
Mailing Address - Phone:410-485-2910
Mailing Address - Fax:
Practice Address - Street 1:5510 NATHAN SHOCK DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6823
Practice Address - Country:US
Practice Address - Phone:410-550-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR052381363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health