Provider Demographics
NPI:1205355328
Name:MARTINEZ-THORNTON, ANGEL PAULINE (RN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:PAULINE
Last Name:MARTINEZ-THORNTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:PAULINE
Other - Last Name:EARLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:57533 MOCCASIN TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-1143
Mailing Address - Country:US
Mailing Address - Phone:405-567-0054
Mailing Address - Fax:
Practice Address - Street 1:57533 MOCCASIN TRAIL RD
Practice Address - Street 2:
Practice Address - City:PRAGUE
Practice Address - State:OK
Practice Address - Zip Code:74864-1143
Practice Address - Country:US
Practice Address - Phone:405-567-0054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0124624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse