Provider Demographics
NPI:1386367449
Name:CLERVIL, MARTINE (FNP-C)
Entity type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:CLERVIL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1221
Mailing Address - Country:US
Mailing Address - Phone:973-733-5310
Mailing Address - Fax:
Practice Address - Street 1:394 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1221
Practice Address - Country:US
Practice Address - Phone:973-733-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01347200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily