Healthcare Provider Details

I. General information

NPI: 1013284090
Provider Name (Legal Business Name): MARTHA OLINDA MEDRANDA R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4547 CARPENTER AVE 2ND FL
BRONX NY
10470-1426
US

IV. Provider business mailing address

4547 CARPENTER AVE 2ND FL
BRONX NY
10470-1426
US

V. Phone/Fax

Practice location:
  • Phone: 914-320-0475
  • Fax:
Mailing address:
  • Phone: 914-320-0475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number646137-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: