Provider Demographics
NPI:1023503794
Name:MARTELLONI, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MARTELLONI
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 1:7126 GREENBANK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1112
Mailing Address - Country:US
Mailing Address - Phone:410-698-2665
Mailing Address - Fax:
Practice Address - Street 1:2581 SAWGRASS LAKE CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33909-2935
Practice Address - Country:US
Practice Address - Phone:410-698-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN34653164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse