Provider Demographics
NPI:1497533905
Name:MARTINEZ, ANAELISE
Entity Type:Individual
Prefix:
First Name:ANAELISE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 DIXON AVE APT 2002
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3989
Mailing Address - Country:US
Mailing Address - Phone:301-922-8982
Mailing Address - Fax:
Practice Address - Street 1:8200 DIXON AVE APT 2002
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3989
Practice Address - Country:US
Practice Address - Phone:301-922-8982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR217853163WC0200X, 163WE0003X, 163WS0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WS0200XNursing Service ProvidersRegistered NurseSchool