Healthcare Provider Details

I. General information

NPI: 1205355328
Provider Name (Legal Business Name): ANGEL PAULINE MARTINEZ-THORNTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGEL PAULINE EARLY RN

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57533 MOCCASIN TRAIL RD
PRAGUE OK
74864-1143
US

IV. Provider business mailing address

57533 MOCCASIN TRAIL RD
PRAGUE OK
74864-1143
US

V. Phone/Fax

Practice location:
  • Phone: 405-567-0054
  • Fax:
Mailing address:
  • Phone: 405-567-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR0124624
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: