Provider Demographics
NPI:1336727155
Name:MARTIN, ELIZABETH HEENAN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:HEENAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08226-3252
Mailing Address - Country:US
Mailing Address - Phone:609-846-6890
Mailing Address - Fax:
Practice Address - Street 1:1101 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-4805
Practice Address - Country:US
Practice Address - Phone:609-344-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08929700163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse