MEDICARE: MADDY RAE MARTINEAU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	NA	AR

General Provider Information

NPI Number	:	1578492898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADDY RAE MARTINEAU

Provider Business Mailing Address
First Line	:	1329 W STADIUM DR
Second Line	:
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72701-4757
Country	:	US
Telephone Number	:	281-965-1046
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 S 52ND ST
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8637
Country	:	US
Telephone Number	:	877-622-4211
Fax Number	:	877-622-4211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “ MADDY RAE MARTINEAU ” Practice Location

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