Provider Information for 1770961062
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WHITNEY LYNN MARTINEZ
Sex: Female
NPI: 1770961062
Last Updated: 2015-05-07
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1770961062 | ||||||||
| Enumeration Date | 2015-05-07 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1213 E SUNSET DR RIVERTON, WY 82501-3036 United States Phone: 307-840-4337 | Fax: | ||||||||
| Primary Practice Address | 107 S BROADWAY AVE STE 213 RIVERTON, WY 82501-4300 United States Phone: 307-463-7541 | Fax: | ||||||||
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