Provider Demographics
NPI:1700108560
Name:MARTIN, CATHERINE JANE (MS RN ANP-BC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:JANE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS RN ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ALFRED ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1972
Mailing Address - Country:US
Mailing Address - Phone:781-756-4700
Mailing Address - Fax:
Practice Address - Street 1:12 ALFRED ST
Practice Address - Street 2:SUITE 207
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-1972
Practice Address - Country:US
Practice Address - Phone:781-756-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223955363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health