=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558951566
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARLENA CHRISTINE MARTINEZ RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2021
-----------------------------------------------------
Last Update Date | 01/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1376 S BOULDER ST UNIT C
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-3772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-510-8506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1376 S BOULDER ST UNIT C
-----------------------------------------------------
City | GILBERT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85296-3772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-510-8506
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | RN162094
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------