Provider Demographics
NPI:1083083059
Name:AUSTIN, MARTHA JEAN (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JEAN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3481 FLATIRON RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14469-9779
Mailing Address - Country:US
Mailing Address - Phone:585-657-5482
Mailing Address - Fax:
Practice Address - Street 1:3481 FLATIRON RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NY
Practice Address - Zip Code:14469-9779
Practice Address - Country:US
Practice Address - Phone:585-657-5482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343468200913E376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide