Provider Demographics
NPI:1407677495
Name:MARTINEZ, BRENDA
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 76
Mailing Address - Street 2:18435 BROAD ST
Mailing Address - City:TONTOGANY
Mailing Address - State:OH
Mailing Address - Zip Code:43565
Mailing Address - Country:US
Mailing Address - Phone:419-409-0594
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 76
Practice Address - Street 2:
Practice Address - City:TONTOGANY
Practice Address - State:OH
Practice Address - Zip Code:43565-0076
Practice Address - Country:US
Practice Address - Phone:419-409-0594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker