Provider Demographics
NPI:1760623664
Name:MARTINEZ, GERISE M (RNFA)
Entity Type:Individual
Prefix:
First Name:GERISE
Middle Name:M
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 N 1000W RD
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-3587
Mailing Address - Country:US
Mailing Address - Phone:815-468-3648
Mailing Address - Fax:
Practice Address - Street 1:8955 N 1000W RD
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-3587
Practice Address - Country:US
Practice Address - Phone:815-468-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041295350163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant