Provider Demographics
NPI:1972930451
Name:MARTINEZ, CORA JOANNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:CORA
Middle Name:JOANNE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CORA
Other - Middle Name:JOANNE
Other - Last Name:BERGSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5507 NW EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5826
Mailing Address - Country:US
Mailing Address - Phone:253-740-7854
Mailing Address - Fax:
Practice Address - Street 1:602 SW 38TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6912
Practice Address - Country:US
Practice Address - Phone:580-248-5436
Practice Address - Fax:580-248-9128
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0061114164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse