Provider Demographics
NPI:1316193931
Name:MARTIN, AMY B (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:156 CORLISS AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2060
Mailing Address - Country:US
Mailing Address - Phone:607-763-6735
Mailing Address - Fax:607-763-6736
Practice Address - Street 1:156 CORLISS AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2060
Practice Address - Country:US
Practice Address - Phone:607-763-6735
Practice Address - Fax:607-763-6736
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4785211367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered