Healthcare Provider Details

I. General information

NPI: 1982910097
Provider Name (Legal Business Name): ORLINDA A MARTINEZ PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2010
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DENIM DR
ERWIN NC
28339-2307
US

IV. Provider business mailing address

901 DENIM DR
ERWIN NC
28339-2307
US

V. Phone/Fax

Practice location:
  • Phone: 910-897-5521
  • Fax: 910-897-2003
Mailing address:
  • Phone: 910-897-5521
  • Fax: 910-897-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-02444
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: