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General NPI Number Information
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NPI Number | 1528764644
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Entity Type | Individual
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Provider Name | LISA M MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 411 N, WV-2
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155
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Country | US
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Telephone | 204-455-5515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 716
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City | NEW MARTINSVILLE
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State | WV
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Zip | 26155-0716
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Country | US
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Telephone | 304-455-5515
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5199661
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License Number State | FL
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