Healthcare Provider Details

I. General information

NPI: 1073332888
Provider Name (Legal Business Name): MARTHA MORALEZ LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARTHA MORALEZ LPN

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8968 HIGHWAY 16
ELKINS AR
72727-8066
US

IV. Provider business mailing address

8968 HIGHWAY 16
ELKINS AR
72727-8066
US

V. Phone/Fax

Practice location:
  • Phone: 479-347-8313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL046647
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: