Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 335252 | NY |
NPI | 1013109354 |
---|---|
Provider Name | Jill Marie Martin |
First Address | Latham, NY 12110-2461 |
Second Address | Scotia, NY 12302-3121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 25/01/2018 |