Provider Demographics
NPI:1659602613
Name:MARTIN, DANYELLE LEA (LVN)
Entity Type:Individual
Prefix:
First Name:DANYELLE
Middle Name:LEA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 VILLAGE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-5650
Mailing Address - Country:US
Mailing Address - Phone:805-944-2644
Mailing Address - Fax:
Practice Address - Street 1:129 VILLAGE CIRCLE DR
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-5650
Practice Address - Country:US
Practice Address - Phone:805-944-2644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA216104164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse