MEDICARE: VANESSA NEREY MARTINEZ

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	124461	AR

General Provider Information

NPI Number	:	1710706692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA NEREY MARTINEZ

Provider Business Mailing Address
First Line	:	3220 SPRINGHILL AVE
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-8891
Country	:	US
Telephone Number	:	786-320-1360
Fax Number	:

Provider Business Practice Location Address
First Line	:	3608 W SOUTHERN HILLS BLVD STE 4
Second Line	:
City	:	ROGERS
State	:	AR
Zip	:	72758-8310
Country	:	US
Telephone Number	:	479-633-7052
Fax Number	:	479-391-5252

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

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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Directions to “ VANESSA NEREY MARTINEZ ” Practice Location

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