MEDICARE: MRS. WANDA ELOISA MARTINEZ RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	642487	TX

General Provider Information

NPI Number	:	1134156078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA ELOISA MARTINEZ RN

Provider Business Mailing Address
First Line	:	36065 SANTA FE AVE
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-5060
Country	:	US
Telephone Number	:	254-618-8125
Fax Number	:

Provider Business Practice Location Address
First Line	:	31ST & BATTELION AVE
Second Line	:	BENNETT HEALTH CLINIC BLD #420
City	:	FT HOOD
State	:	TX
Zip	:	76544-4752
Country	:	US
Telephone Number	:	254-618-8067
Fax Number	:	254-618-8099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	02/12/2021

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