Provider Demographics
NPI:1619363124
Name:MARTIN, HEIDI M (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 MERCHANTS CONCOURSE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-5142
Mailing Address - Country:US
Mailing Address - Phone:516-565-6322
Mailing Address - Fax:516-565-6325
Practice Address - Street 1:900 MERCHANTS CONCOURSE
Practice Address - Street 2:SUITE 216
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5142
Practice Address - Country:US
Practice Address - Phone:516-565-6322
Practice Address - Fax:516-565-6325
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY499912163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse