Provider Demographics
NPI:1336751999
Name:MARTINEZ, CASSANDRA E (BSN, RN)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:E
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:16557 N 157TH AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4324
Mailing Address - Country:US
Mailing Address - Phone:928-580-5412
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226413163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics