Healthcare Provider Details

I. General information

NPI: 1497533905
Provider Name (Legal Business Name): ANAELISE MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 09/18/2023
Certification Date: 09/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DIXON AVE APT 2002
SILVER SPRING MD
20910-3989
US

IV. Provider business mailing address

8200 DIXON AVE APT 2002
SILVER SPRING MD
20910-3989
US

V. Phone/Fax

Practice location:
  • Phone: 301-922-8982
  • Fax:
Mailing address:
  • Phone: 301-922-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR217853
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR217853
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR217853
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR217853
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: