Healthcare Provider Details

I. General information

NPI: 1952582439
Provider Name (Legal Business Name): SARA ELIZABETH MARTINEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 N MAIN ST
VIROQUA WI
54665-1156
US

IV. Provider business mailing address

66 E 3RD ST 201
WINONA MN
55987-3478
US

V. Phone/Fax

Practice location:
  • Phone: 608-637-7052
  • Fax: 608-637-8500
Mailing address:
  • Phone: 507-452-7292
  • Fax: 507-457-9887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: