Provider Demographics
NPI:1952061566
Name:MARTIN, LEWANDA (LVN)
Entity Type:Individual
Prefix:
First Name:LEWANDA
Middle Name:
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 1:143 FOREST SERVICE ROAD 233
Mailing Address - Street 2:
Mailing Address - City:NEW WAVERLY
Mailing Address - State:TX
Mailing Address - Zip Code:77358-3945
Mailing Address - Country:US
Mailing Address - Phone:936-344-7819
Mailing Address - Fax:936-344-7267
Practice Address - Street 1:143 FOREST SERVICE ROAD 233
Practice Address - Street 2:
Practice Address - City:NEW WAVERLY
Practice Address - State:TX
Practice Address - Zip Code:77358-3945
Practice Address - Country:US
Practice Address - Phone:936-344-7819
Practice Address - Fax:936-344-7267
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166117164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse