Provider Demographics
NPI:1366915662
Name:MARTINEZ, ERICA PAOLA (NC60483936)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:PAOLA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NC60483936
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 C ST NW
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:WA
Mailing Address - Zip Code:98848-1016
Mailing Address - Country:US
Mailing Address - Phone:509-289-7527
Mailing Address - Fax:
Practice Address - Street 1:8 C ST NW
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:WA
Practice Address - Zip Code:98848-1016
Practice Address - Country:US
Practice Address - Phone:509-289-7527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANC60483936376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANC60483936Medicaid