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General NPI Number Information
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NPI Number | 1053109793
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Entity Type | Individual
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Provider Name | YENISLEYDI MARTINEZ MEDINA
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Gender | Female
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 721 S 1ST AVE APT 101
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City | HASTINGS
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State | NE
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Zip | 68901-6605
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Country | US
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Telephone | 402-705-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 518 S KANSAS AVE
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City | HASTINGS
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State | NE
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Zip | 68901-6127
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Country | US
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Telephone | 402-460-7868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 17935788
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License Number State | NE
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