Provider Demographics
NPI:1629543038
Name:MARTINEZ, MARLEN ELIZABETH (NP)
Entity type:Individual
Prefix:MS
First Name:MARLEN
Middle Name:ELIZABETH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARLEN
Other - Middle Name:ELIZABETH
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1555 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2910
Mailing Address - Country:US
Mailing Address - Phone:718-765-6357
Mailing Address - Fax:347-523-8127
Practice Address - Street 1:1555 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2910
Practice Address - Country:US
Practice Address - Phone:718-765-6367
Practice Address - Fax:347-523-8127
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily