Provider Demographics
NPI:1659765444
Name:MARTINEZ, AMY BETH (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6771 PRESCOTT DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9524
Mailing Address - Country:US
Mailing Address - Phone:716-208-0712
Mailing Address - Fax:
Practice Address - Street 1:6771 PRESCOTT DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:NY
Practice Address - Zip Code:14047-9524
Practice Address - Country:US
Practice Address - Phone:716-208-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691563-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health