Provider Demographics
NPI:1962078592
Name:MARTINDALE, RENEE LYNN (RN, BSN)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:LYNN
Last Name:MARTINDALE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:LYNN
Other - Last Name:ROCHE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:7320 SNELL HILL RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7630
Mailing Address - Country:US
Mailing Address - Phone:607-346-7108
Mailing Address - Fax:607-664-1498
Practice Address - Street 1:7320 SNELL HILL RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7630
Practice Address - Country:US
Practice Address - Phone:607-346-7108
Practice Address - Fax:607-664-1498
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY588818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse