Provider Demographics
NPI:1134156078
Name:MARTINEZ, WANDA ELOISA (RN)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:ELOISA
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 1:36065 SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-5060
Mailing Address - Country:US
Mailing Address - Phone:254-618-8125
Mailing Address - Fax:
Practice Address - Street 1:31ST & BATTELION AVE
Practice Address - Street 2:BENNETT HEALTH CLINIC BLD #420
Practice Address - City:FT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-4752
Practice Address - Country:US
Practice Address - Phone:254-618-8067
Practice Address - Fax:254-618-8099
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX642487163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management