Healthcare Provider Details

I. General information

NPI: 1043128291
Provider Name (Legal Business Name): CRYSTAL L MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HIGH ST
ALVA OK
73717-3109
US

IV. Provider business mailing address

405 HIGH ST
ALVA OK
73717-3109
US

V. Phone/Fax

Practice location:
  • Phone: 580-430-1757
  • Fax:
Mailing address:
  • Phone: 580-430-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR0086482
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: