Provider Demographics
NPI:1225380447
Name:MARTINEZ, DENISE (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 MEDICAL CENTER CIR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18106-9661
Mailing Address - Country:US
Mailing Address - Phone:484-876-5649
Mailing Address - Fax:
Practice Address - Street 1:5018 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 240
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9661
Practice Address - Country:US
Practice Address - Phone:484-876-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012316363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103181145 0001Medicaid
PA261399FRHOtherMEDICARE PTAN
PA50113665OtherCAPITAL BLUE CROSS
PA103181145 0001Medicaid