Provider Demographics
NPI:1912715442
Name:HACKER, MOLYNE MARTINEZ (LVN)
Entity type:Individual
Prefix:
First Name:MOLYNE
Middle Name:MARTINEZ
Last Name:HACKER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MOLYNE
Other - Middle Name:MARTINEZ
Other - Last Name:HACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOLYNE MARTINEZ
Mailing Address - Street 1:622 DOC HOLIDAY DR
Mailing Address - Street 2:
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003
Mailing Address - Country:US
Mailing Address - Phone:512-999-4364
Mailing Address - Fax:
Practice Address - Street 1:622 DOC HOLIDAY DR
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:512-999-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1066061364SL0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SL0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistLong-Term Care