Provider Demographics
NPI:1043019144
Name:MARTINEZ, NICOLE R (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:MARTINEZ
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19863 MOUNTAIN MDW S
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8570
Mailing Address - Country:US
Mailing Address - Phone:707-472-1309
Mailing Address - Fax:
Practice Address - Street 1:925 BEVINS CT
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-9754
Practice Address - Country:US
Practice Address - Phone:707-263-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95382888163WC1600X, 163WD0400X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator