Provider Demographics
NPI:1912024266
Name:MARTZ, MARYELLEN SCHADE (RNII)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:SCHADE
Last Name:MARTZ
Suffix:
Gender:F
Credentials:RNII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2675
Mailing Address - Street 2:DPW-OMHSAS LOGAN BUILDING
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17105-2675
Mailing Address - Country:US
Mailing Address - Phone:717-214-8200
Mailing Address - Fax:717-772-7699
Practice Address - Street 1:120 EAST AZALEA DRIVE
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3594
Practice Address - Country:US
Practice Address - Phone:717-214-8200
Practice Address - Fax:717-772-7699
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN331910L163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult