Individual
MS. LIRA R MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1501 S MADISON ST, APPLETON, WI 54915-1846
(920) 730-4443
Mailing address
PO BOX 1047, NEENAH, WI 54957-1047
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2850
WI
Other
Enumeration date
10/31/2011
Last updated
09/15/2012
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