Healthcare Provider Details

I. General information

NPI: 1578492898
Provider Name (Legal Business Name): MADDY RAE MARTINEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 S 52ND ST
ROGERS AR
72758-8637
US

IV. Provider business mailing address

1329 W STADIUM DR
FAYETTEVILLE AR
72701-4757
US

V. Phone/Fax

Practice location:
  • Phone: 877-622-4211
  • Fax: 877-622-4211
Mailing address:
  • Phone: 281-965-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberNA
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: