Individual
VIVIAN D. MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
HIGHWAY 191 & HOSPITAL ROAD, CHINLE COMPREHENSIVE HEALTH CARE FACILITY, CHINLE, AZ 86503
(928) 674-7205
(928) 674-7705
Mailing address
P.O. DRAWER PH, CHINLE COMPREHENSIVE HEALTH CARE FACILITY, CHINLE, AZ 86503
(928) 674-7205
(928) 674-7705
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
055791
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055791
STATE BOARD OF NURSING LICENSE
MO
Enumeration date
11/30/2010
Last updated
11/30/2010
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