Healthcare Provider Details

I. General information

NPI: 1881435568
Provider Name (Legal Business Name): MARTINA HEIDEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WASHINGTON ST
ELMIRA NY
14901-2849
US

IV. Provider business mailing address

100 WASHINGTON ST
ELMIRA NY
14901-2849
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-4700
  • Fax:
Mailing address:
  • Phone: 607-737-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number741678
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: