Provider Demographics
NPI:1538390828
Name:MARTINKUS, KAROLYN RENEE (PA)
Entity type:Individual
Prefix:MS
First Name:KAROLYN
Middle Name:RENEE
Last Name:MARTINKUS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:5965 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:FIRESTONE
Mailing Address - State:CO
Mailing Address - Zip Code:80504-6607
Mailing Address - Country:US
Mailing Address - Phone:720-652-7055
Mailing Address - Fax:720-652-7056
Practice Address - Street 1:5965 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:FIRESTONE
Practice Address - State:CO
Practice Address - Zip Code:80504-6607
Practice Address - Country:US
Practice Address - Phone:720-652-7055
Practice Address - Fax:720-652-7056
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0002844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO305850Medicare PIN