Basic Information
| Provider Information | |||||||||
| NPI: | 1346861978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINEZ | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN, NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1553 CHESTER PIKE STE 201 | ||||||||
| Address2: | |||||||||
| City: | CRUM LYNNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190221022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104997181 | ||||||||
| FaxNumber: | 6108760859 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 W BALTIMORE AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | MEDIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190633740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4842270900 | ||||||||
| FaxNumber: | 4843247660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2020 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | SP021931 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.