Provider Demographics
NPI:1770222085
Name:MARTINEZ, LAURIE GRANITO (RN)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:GRANITO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 W CAPRIANA DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-2687
Mailing Address - Country:US
Mailing Address - Phone:714-720-3224
Mailing Address - Fax:
Practice Address - Street 1:2898 W CAPRIANA DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-2687
Practice Address - Country:US
Practice Address - Phone:714-720-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID72157163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator