Provider Demographics
NPI:1447737002
Name:JIMENEZ-MARTINEZ, GRACIELA (NP)
Entity Type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:JIMENEZ-MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 N MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1156
Mailing Address - Country:US
Mailing Address - Phone:574-209-1130
Mailing Address - Fax:
Practice Address - Street 1:1217 W PLYMOUTH ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1930
Practice Address - Country:US
Practice Address - Phone:574-546-0654
Practice Address - Fax:888-815-1434
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28192998A163W00000X
IN71008159A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse