Provider Demographics
NPI:1427001106
Name:MARTINEZ, STEFANIE J (NP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:J
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:109 FLEETWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-2019
Practice Address - Country:US
Practice Address - Phone:864-442-7618
Practice Address - Fax:864-442-7155
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2659363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1139Medicaid
SC1528299732OtherNPI FOR FLEETWOOD CONVENIENT CARE/MEDICAL CENTER EASLEY
SCAA1139 6952Medicaid
SCNP1139Medicaid
SCAA1453 9368Medicare PIN