Provider Demographics
NPI:1013701416
Name:WASLEY, MARTINA ISABEL (MD)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:ISABEL
Last Name:WASLEY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:ISABEL
Other - Last Name:LANGE-FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5420 LA BRIANA CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4585
Mailing Address - Country:US
Mailing Address - Phone:650-293-1995
Mailing Address - Fax:
Practice Address - Street 1:116 N PAULINE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-1005
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program