Provider Demographics
NPI:1053109793
Name:MARTINEZ MEDINA, YENISLEYDI
Entity type:Individual
Prefix:
First Name:YENISLEYDI
Middle Name:
Last Name:MARTINEZ MEDINA
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 1:518 S KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6127
Mailing Address - Country:US
Mailing Address - Phone:402-460-7868
Mailing Address - Fax:
Practice Address - Street 1:721 S 1ST AVE APT 101
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6605
Practice Address - Country:US
Practice Address - Phone:402-705-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17935788372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider