Provider Demographics
NPI:1952950701
Name:MARTINUZZI, KAITLIN SUZANNE (PNP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:SUZANNE
Last Name:MARTINUZZI
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8110 HEALTHCARE LOOP
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-7069
Practice Address - Country:US
Practice Address - Phone:704-316-2312
Practice Address - Fax:704-316-2316
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012210363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics