Provider Demographics
NPI:1912448622
Name:MARTIN, KRISTEN (NP)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 UNICORN PARK DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3365
Mailing Address - Country:US
Mailing Address - Phone:781-338-7521
Mailing Address - Fax:781-338-7525
Practice Address - Street 1:400 UNICORN PARK DR
Practice Address - Street 2:4TH FLOOR
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3365
Practice Address - Country:US
Practice Address - Phone:781-338-7521
Practice Address - Fax:781-338-7525
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN283929363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner