Individual
COLLEEN MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
717 N SANTA ANNA, MESA, AZ 85201-4429
(480) 688-0521
Mailing address
717 N SANTA ANNA, MESA, AZ 85201-4429
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP045839
AZ
Other
Enumeration date
09/26/2017
Last updated
09/26/2017
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