Healthcare Provider Details

I. General information

NPI: 1730434093
Provider Name (Legal Business Name): KATHARINE MARIA MARTINUCCI FNP, MSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 THROGGS NECK BLVD
BRONX NY
10465-3800
US

IV. Provider business mailing address

3 THROGGS NECK BLVD
BRONX NY
10465-3800
US

V. Phone/Fax

Practice location:
  • Phone: 347-865-2873
  • Fax:
Mailing address:
  • Phone: 347-865-2873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number22 601869
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33 337188
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: