Provider Demographics
NPI:1730434093
Name:MARTINUCCI, KATHARINE MARIA (FNP, MSN, RN)
Entity type:Individual
Prefix:MS
First Name:KATHARINE
Middle Name:MARIA
Last Name:MARTINUCCI
Suffix:
Gender:F
Credentials:FNP, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:3 THROGGS NECK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-3800
Mailing Address - Country:US
Mailing Address - Phone:347-865-2873
Mailing Address - Fax:
Practice Address - Street 1:3 THROGGS NECK BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-3800
Practice Address - Country:US
Practice Address - Phone:347-865-2873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 601869163WN0002X
NY33 337188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care