1295706653 NPI number — MARILYNN M MARTIN CRNP

Table of content: MARILYNN M MARTIN CRNP (NPI 1295706653)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295706653 NPI number — MARILYNN M MARTIN CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
MARILYNN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295706653
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 LIBERTY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-432-3163
Provider Business Mailing Address Fax Number:
814-437-2417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 LIBERTY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-432-3163
Provider Business Practice Location Address Fax Number:
814-437-2417
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN234220L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: SP000520G , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00132133 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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