Basic Information
| Provider Information | |||||||||
| NPI: | 1326424953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | GRECIA | ||||||||
| MiddleName: | VANESSA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 S MAIN ST | ||||||||
| Address2: | STE C | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785015055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566860574 | ||||||||
| FaxNumber: | 9566863301 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 S MAIN ST | ||||||||
| Address2: | STE C | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785015055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566860574 | ||||||||
| FaxNumber: | 9566863301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2015 | ||||||||
| LastUpdateDate: | 11/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP128728 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 439369YLPS | 01 | TX | WELLMED PTAN | OTHER |