Provider Demographics
NPI:1104302827
Name:MARTINEZ, KATHRYN (CRNP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 UNION AVE # 2E
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1039
Mailing Address - Country:US
Mailing Address - Phone:908-339-2147
Mailing Address - Fax:
Practice Address - Street 1:127 UNION AVE STE 2E
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-1039
Practice Address - Country:US
Practice Address - Phone:908-339-2147
Practice Address - Fax:908-760-4703
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN654742363L00000X
NJ26NJ00871900363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner