Provider Demographics
NPI:1487250494
Name:MARTINEZ RODRIGUEZ, STEPHANIE (LVN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MARTINEZ RODRIGUEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:NEEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:435-751-2472
Mailing Address - Fax:512-703-1394
Practice Address - Street 1:12517 LA PAZ
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3677
Practice Address - Country:US
Practice Address - Phone:512-276-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336032164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse