Provider Demographics
NPI:1790010114
Name:MARTINO, LISA ANN (RN)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:ANN
Last Name:MARTINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8588 PUMP RD
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-8700
Mailing Address - Country:US
Mailing Address - Phone:315-689-9153
Mailing Address - Fax:
Practice Address - Street 1:8588 PUMP RD
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-8700
Practice Address - Country:US
Practice Address - Phone:315-689-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-04
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-615031163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse