Provider Demographics
NPI:1306441795
Name:MARTINEZ, BRENDA ANN (QSP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:ANN
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:QSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 18TH ST S APT 4
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6758
Mailing Address - Country:US
Mailing Address - Phone:701-799-1436
Mailing Address - Fax:
Practice Address - Street 1:2814 18TH ST S APT 4
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6758
Practice Address - Country:US
Practice Address - Phone:701-799-1436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health