Provider Demographics
NPI:1922645241
Name:MARTINEZ, LAURA JEANENE
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEANENE
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 1:232 RUSTLING WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:TOWAOC
Mailing Address - State:CO
Mailing Address - Zip Code:81334-5062
Mailing Address - Country:US
Mailing Address - Phone:970-565-4441
Mailing Address - Fax:
Practice Address - Street 1:232 RUSTLING WILLOW ST
Practice Address - Street 2:
Practice Address - City:TOWAOC
Practice Address - State:CO
Practice Address - Zip Code:81334-5062
Practice Address - Country:US
Practice Address - Phone:970-565-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1626525163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn