Provider Demographics
NPI:1285021162
Name:MARTORANA, ELEZA MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:ELEZA
Middle Name:MICHELE
Last Name:MARTORANA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15336 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-8296
Mailing Address - Country:US
Mailing Address - Phone:619-920-5902
Mailing Address - Fax:
Practice Address - Street 1:15336 LAKEVIEW CT
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-8296
Practice Address - Country:US
Practice Address - Phone:619-920-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR899081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse