Healthcare Provider Details

I. General information

NPI: 1538024740
Provider Name (Legal Business Name): KATHERINE MARTE-DOMINGUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BORDENTOWN AVE
PARLIN NJ
08859-1851
US

IV. Provider business mailing address

1145 BORDENTOWN AVE
PARLIN NJ
08859-1851
US

V. Phone/Fax

Practice location:
  • Phone: 908-386-1611
  • Fax:
Mailing address:
  • Phone: 908-386-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number26NR27259500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: