Provider Demographics
NPI:1659336121
Name:MARTIN, JAYNE L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:L
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:JAYNE
Other - Middle Name:L
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3104 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2820
Mailing Address - Country:US
Mailing Address - Phone:814-226-5500
Mailing Address - Fax:
Practice Address - Street 1:3104 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2820
Practice Address - Country:US
Practice Address - Phone:814-226-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP006257G363LX0001X
PARN519930L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR344557OtherHIGHMARK
PA1991407OtherHIGHMARK
PAPO0249928OtherMEDICARE RAILROAD CARRIER
PA042092L55Medicare PIN
PAPO0249928OtherMEDICARE RAILROAD CARRIER
PA042092PAZMedicare PIN
PA1991407OtherHIGHMARK