Provider Demographics
NPI:1295706653
Name:MARTIN, MARILYNN M (CRNP)
Entity type:Individual
Prefix:
First Name:MARILYNN
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323
Mailing Address - Country:US
Mailing Address - Phone:814-432-3163
Mailing Address - Fax:814-437-2417
Practice Address - Street 1:1310 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323
Practice Address - Country:US
Practice Address - Phone:814-432-3163
Practice Address - Fax:814-437-2417
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN234220L163W00000X
PASP000520G363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00132133Medicaid
PAP00132133Medicaid
PA006280FFXMedicare ID - Type Unspecified