Provider Demographics
NPI:1881332708
Name:MARTIN, JENNIFER MAE (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 S 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-8840
Mailing Address - Country:US
Mailing Address - Phone:717-701-1582
Mailing Address - Fax:
Practice Address - Street 1:920 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-4656
Practice Address - Country:US
Practice Address - Phone:717-272-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP02284363LF0000X
PASP022284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily