Provider Demographics
NPI:1467283093
Name:MARTINEZ, EUNICE BIANCA MAE MANALO (RN)
Entity type:Individual
Prefix:
First Name:EUNICE BIANCA MAE
Middle Name:MANALO
Last Name:MARTINEZ
Suffix:
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 1:3818 AVENUE D APT 11
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4644
Mailing Address - Country:US
Mailing Address - Phone:402-874-4130
Mailing Address - Fax:
Practice Address - Street 1:4021 AVENUE B
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4602
Practice Address - Country:US
Practice Address - Phone:308-635-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00318421163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitationGroup - Single Specialty