Provider Demographics
NPI:1760759286
Name:MARTINEZ, JANEL
Entity Type:Individual
Prefix:
First Name:JANEL
Middle Name:
Last Name:MARTINEZ
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 1:15 BIG CROSS ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4213
Mailing Address - Country:US
Mailing Address - Phone:518-792-2619
Mailing Address - Fax:518-792-2668
Practice Address - Street 1:15 BIG CROSS ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4213
Practice Address - Country:US
Practice Address - Phone:518-792-2619
Practice Address - Fax:518-792-2668
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306724-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool