Basic Information
| Provider Information | |||||||||
| NPI: | 1780120519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTZ | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 E ALLEN ST | ||||||||
| Address2: | APT 1 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191254237 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 15000 MIDLANTIC DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MOUNT LAUREL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080541573 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8568299345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2017 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 26NR18553600 | NJ | Y | Nursing Service Providers | Registered Nurse | 163W00000X | RN658164 | PA | N | Nursing Service Providers | Registered Nurse |
No ID Information.