Provider Demographics
NPI:1366943458
Name:MARTIN, LOLA LAKATE I (RN)
Entity type:Individual
Prefix:MISS
First Name:LOLA
Middle Name:LAKATE
Last Name:MARTIN
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 LEORA LN APT 718
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4008
Mailing Address - Country:US
Mailing Address - Phone:903-724-4268
Mailing Address - Fax:
Practice Address - Street 1:650 LEORA LN APT 718
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75056-4008
Practice Address - Country:US
Practice Address - Phone:903-724-4268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX829787163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse