Provider Demographics
NPI:1124386974
Name:HYACINTHE, MARTINE C (LPN)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:C
Last Name:HYACINTHE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MARTINE
Other - Middle Name:CONSTANT
Other - Last Name:HYACINTHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:205 PAYNE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT WOLF
Mailing Address - State:PA
Mailing Address - Zip Code:17347-9227
Mailing Address - Country:US
Mailing Address - Phone:717-779-6603
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD STE 204
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:800-879-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA284700164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse