Healthcare Provider Details

I. General information

NPI: 1811815350
Provider Name (Legal Business Name): MICKALE MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WATER GRANT ST
YONKERS NY
10701-3600
US

IV. Provider business mailing address

20 WATER GRANT ST APT 472
YONKERS NY
10701-3753
US

V. Phone/Fax

Practice location:
  • Phone: 914-562-1738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number433556
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: