Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SP013525 | PA |
NPI | 1043621311 |
---|---|
Provider Name | Brittany Elizabeth Martynov |
First Address | Langhorne, PA 19047-8026 |
Second Address | Yardley, PA 19067-6421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2014 |
Last Update Date | 08/05/2014 |