Healthcare Provider Details

I. General information

NPI: 1043659592
Provider Name (Legal Business Name): LISA MARIE MARTINEZ CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA GERGAR CRNP

II. Dates (important events)

Enumeration Date: 06/18/2013
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3365 HIGH POINT BLVD
BETHLEHEM PA
18017-7806
US

IV. Provider business mailing address

3365 HIGH POINT BLVD
BETHLEHEM PA
18017-7806
US

V. Phone/Fax

Practice location:
  • Phone: 610-954-5433
  • Fax:
Mailing address:
  • Phone: 610-954-5433
  • Fax: 610-691-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP007587
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: