Provider Demographics
NPI:1841895406
Name:MARTINEZ, ROBERT P (BSN, RN)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GAWRON RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSON
Mailing Address - State:CT
Mailing Address - Zip Code:06277-2203
Mailing Address - Country:US
Mailing Address - Phone:401-484-8262
Mailing Address - Fax:
Practice Address - Street 1:3300 MAIN ST RM 190
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1112
Practice Address - Country:US
Practice Address - Phone:413-794-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278224163WE0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency