Provider Demographics
NPI:1629347349
Name:MARTINEZ, MAKRISTINA ATENCIO (CRNP)
Entity Type:Individual
Prefix:
First Name:MAKRISTINA
Middle Name:ATENCIO
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MA.KRISTINA
Other - Middle Name:ATENCIO
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:1244 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-1743
Mailing Address - Country:US
Mailing Address - Phone:215-646-6504
Mailing Address - Fax:215-646-6546
Practice Address - Street 1:1244 FORT WASHINGTON AVE STE N1
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-1743
Practice Address - Country:US
Practice Address - Phone:215-646-6504
Practice Address - Fax:215-646-6546
Is Sole Proprietor?:No
Enumeration Date:2011-12-26
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPO11863363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health