Healthcare Provider Details

I. General information

NPI: 1780120519
Provider Name (Legal Business Name): AMY RENEE MARTZ CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 MIDLANTIC DR SUITE 102
MOUNT LAUREL NJ
08054-1573
US

IV. Provider business mailing address

327 E ALLEN ST APT 1
PHILADELPHIA PA
19125-4237
US

V. Phone/Fax

Practice location:
  • Phone: 856-829-9345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00699600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR18553600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN658164
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: