Healthcare Provider Details

I. General information

NPI: 1205940640
Provider Name (Legal Business Name): REBECCA ROSE MARTINE APRN, CS, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

63 AVON RD
HADDONFIELD NJ
08033-3930
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5934
  • Fax:
Mailing address:
  • Phone: 856-547-7347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SN0800X
TaxonomyNeuroscience Clinical Nurse Specialist
License NumberRN526306L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN526306L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code364SP0813X
TaxonomyGeropsychiatric Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN526306L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: