Healthcare Provider Details

I. General information

NPI: 1003910548
Provider Name (Legal Business Name): KATHLEEN MARTENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 ROSEDALE AVE APT 517
BETHESDA MD
20814-3760
US

IV. Provider business mailing address

10 TALL TREE DR
BEVERLY MA
01915-2012
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0961
  • Fax:
Mailing address:
  • Phone: 978-979-7410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number179866
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: