Individual
MRS. LUELLA PAULINE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
11800 W THOMPSON RANCH RD, EL MIRAGE, AZ 85335-3208
(623) 523-8404
(623) 523-8411
Mailing address
17061 W HALIFAX LN, SURPRISE, AZ 85374-6887
(623) 266-3028
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP039599
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
897043
—
AZ
Enumeration date
03/05/2007
Last updated
07/08/2007
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