Provider Demographics
NPI:1013385681
Name:MARTYN, TANYA (RN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:MARTYN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 PULLING RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540-6024
Mailing Address - Country:US
Mailing Address - Phone:845-592-1721
Mailing Address - Fax:
Practice Address - Street 1:1657 E NOXON RD
Practice Address - Street 2:
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-4302
Practice Address - Country:US
Practice Address - Phone:845-223-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY505269-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse