MEDICARE: CRYSTAL MARTINEZ NP

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	363LF0000X	Family Nurse Practitioner	289876	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5011600	NC

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	:	1972068757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL MARTINEZ NP

Provider Business Mailing Address
First Line	:	3151 DALLAS HIGH SHOALS HWY UNIT 935
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-1369
Country	:	US
Telephone Number	:	803-470-5358
Fax Number	:

Provider Business Practice Location Address
First Line	:	3151 DALLAS HIGH SHOALS HWY UNIT 935
Second Line	:
City	:	DALLAS
State	:	NC
Zip	:	28034-1369
Country	:	US
Telephone Number	:	803-470-5358
Fax Number	:

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

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	09/09/2022

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Directions to “ CRYSTAL MARTINEZ NP” Practice Location

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