Provider Demographics
NPI:1457117210
Name:MARTONIK, MICHALIAH
Entity Type:Individual
Prefix:
First Name:MICHALIAH
Middle Name:
Last Name:MARTONIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHALIAH
Other - Middle Name:
Other - Last Name:KOEHNLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:157 CRANBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-9118
Mailing Address - Country:US
Mailing Address - Phone:740-632-1800
Mailing Address - Fax:
Practice Address - Street 1:320 E NORTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4772
Practice Address - Country:US
Practice Address - Phone:412-359-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA705024163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse