Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN538113 | PA |
NPI | 1174123079 |
---|---|
Provider Name | Kelli Lynn Martin |
First Address | Bethlehem, PA 18017-8891 |
Second Address | Bethlehem, PA 18015-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 29/10/2020 |