Provider Demographics
NPI:1326000225
Name:KLAY, MARTHA (RN, MSN, APRN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:KLAY
Suffix:
Gender:F
Credentials:RN, MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 EAST ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1433
Mailing Address - Country:US
Mailing Address - Phone:413-429-6165
Mailing Address - Fax:413-528-6594
Practice Address - Street 1:115 EAST ST
Practice Address - Street 2:
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-1433
Practice Address - Country:US
Practice Address - Phone:413-429-6165
Practice Address - Fax:413-528-6594
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000802164W00000X
MA158733164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004202800Medicaid
MA0723908Medicaid
MANP5340Medicare PIN
CT500000733Medicare PIN