Provider Demographics
NPI:1013284090
Name:MEDRANDA, MARTHA OLINDA (RN)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:OLINDA
Last Name:MEDRANDA
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 1:4547 CARPENTER AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1426
Mailing Address - Country:US
Mailing Address - Phone:914-320-0475
Mailing Address - Fax:
Practice Address - Street 1:4547 CARPENTER AVE
Practice Address - Street 2:2ND FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1426
Practice Address - Country:US
Practice Address - Phone:914-320-0475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646137-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool