Provider Demographics
NPI:1558630871
Name:MARTIN, CHRISTINA JILL
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:JILL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 ROUTE 88 N
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-9226
Mailing Address - Country:US
Mailing Address - Phone:315-331-6264
Mailing Address - Fax:
Practice Address - Street 1:3723 ROUTE 88 N
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-9226
Practice Address - Country:US
Practice Address - Phone:315-331-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282303-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse