=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457838708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUELINE MARTINEZ VELA RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2018
-----------------------------------------------------
Last Update Date | 04/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2102 W TEEGE AVE
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-4667
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-412-3337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 E AVENUE I
-----------------------------------------------------
City | ROBSTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78380-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-876-7236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 875045
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------