Provider Demographics
NPI:1366490153
Name:MARTINEZ, CHERIE R (PA-C)
Entity type:Individual
Prefix:
First Name:CHERIE
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 REYNOLDS ROAD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2300
Mailing Address - Country:US
Mailing Address - Phone:402-727-1091
Mailing Address - Fax:402-727-7628
Practice Address - Street 1:710 REYNOLDS ROAD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2300
Practice Address - Country:US
Practice Address - Phone:402-727-1091
Practice Address - Fax:402-727-7628
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE766363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278820Medicare ID - Type Unspecified
NEP26539Medicare UPIN