Provider Demographics
NPI:1366179111
Name:ETUDOR, ESMERALDA MARTINEZ (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:ESMERALDA
Middle Name:MARTINEZ
Last Name:ETUDOR
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5187 PORTER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-8133
Mailing Address - Country:US
Mailing Address - Phone:956-243-5114
Mailing Address - Fax:
Practice Address - Street 1:201 PARK AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3719
Practice Address - Country:US
Practice Address - Phone:928-717-3249
Practice Address - Fax:928-717-3248
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ242856163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse