Provider Demographics
NPI:1497325146
Name:PATERRA, MARTINE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:MARIE
Last Name:PATERRA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11848 BAYPORT LN APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3800
Mailing Address - Country:US
Mailing Address - Phone:949-554-5756
Mailing Address - Fax:
Practice Address - Street 1:11848 BAYPORT LN APT 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3800
Practice Address - Country:US
Practice Address - Phone:949-554-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5429301164W00000X
FLPN5249301164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse