Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP60691531 | WA |
NPI | 1013307149 |
---|---|
Provider Name | Katrina Martinez |
First Address | Fort Lee, VA 23801-1716 |
Second Address | Moseley, VA 23120-1582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2015 |
Last Update Date | 20/11/2020 |