Provider Demographics
NPI:1568703031
Name:MARTINEAU, MAWASI ANGEL (LPN)
Entity Type:Individual
Prefix:
First Name:MAWASI
Middle Name:ANGEL
Last Name:MARTINEAU
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 1:3789 GARDNER AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3357
Mailing Address - Country:US
Mailing Address - Phone:954-865-8018
Mailing Address - Fax:
Practice Address - Street 1:3789 GARDNER AVE
Practice Address - Street 2:APT 3
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3357
Practice Address - Country:US
Practice Address - Phone:954-865-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148550164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse