Provider Demographics
NPI:1528394145
Name:MARTINEZ, RENEE DELORES (LPN)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:DELORES
Last Name:MARTINEZ
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 1:1 COLECHESTER CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2154
Mailing Address - Country:US
Mailing Address - Phone:269-556-0043
Mailing Address - Fax:
Practice Address - Street 1:1 COLECHESTER CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2154
Practice Address - Country:US
Practice Address - Phone:269-556-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703089447164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse