Provider Demographics
NPI:1841459591
Name:MARTINO, MICHELLE RENEE (RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:MARTINO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COLORADO STATE UNIVERSITY
Mailing Address - Street 2:8031 HARTSHORN HEALTH SERVICES
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80523-0001
Mailing Address - Country:US
Mailing Address - Phone:970-491-7121
Mailing Address - Fax:970-491-0226
Practice Address - Street 1:COLORADO STATE UNIVERSITY
Practice Address - Street 2:8031 HARTSHORN HEALTH SERVICES
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80523-0001
Practice Address - Country:US
Practice Address - Phone:970-491-7121
Practice Address - Fax:970-491-0226
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO170842163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health