Healthcare Provider Details

I. General information

NPI: 1902095193
Provider Name (Legal Business Name): MARY ELIZABETH MARTIN RN, BS,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUSINESS ROUTE 209 AND BOSSARDSVILLE ROAD
SCIOTA PA
18354
US

IV. Provider business mailing address

PO BOX 507
SCIOTA PA
18354-0507
US

V. Phone/Fax

Practice location:
  • Phone: 570-992-6300
  • Fax: 570-402-2900
Mailing address:
  • Phone: 570-992-6300
  • Fax: 570-402-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN243814L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: