MEDICARE: MRS. GWENDOLYN SUE MARTINEZ CRNA

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	367500000X	Certified Registered Nurse Anesthetist	0024166964	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851327993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GWENDOLYN SUE MARTINEZ CRNA

Provider Business Mailing Address
First Line	:	3100 SPRING FOREST RD
Second Line	:	SUITE 130
City	:	RALEIGH
State	:	NC
Zip	:	27616-2880
Country	:	US
Telephone Number	:	919-882-0705
Fax Number	:	919-873-9821

Provider Business Practice Location Address
First Line	:	3100 SPRING FOREST RD
Second Line	:	SUITE 130
City	:	RALEIGH
State	:	NC
Zip	:	27616-2880
Country	:	US
Telephone Number	:	919-882-0705
Fax Number	:	919-873-9821

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	10/25/2023

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