Provider Demographics
NPI:1346866936
Name:MARTINEAU, ELISJA ANDREA
Entity Type:Individual
Prefix:
First Name:ELISJA
Middle Name:ANDREA
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 S MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01360-9685
Mailing Address - Country:US
Mailing Address - Phone:413-885-6318
Mailing Address - Fax:
Practice Address - Street 1:515 S MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MA
Practice Address - Zip Code:01360-9685
Practice Address - Country:US
Practice Address - Phone:413-885-6318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2261121163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health