Individual
COLLEEN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11 KELLY CT APT 11, STORMVILLE, NY 12582-5610
(845) 293-9289
Mailing address
11 KELLY CT APT 11, STORMVILLE, NY 12582-5610
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
319808
NY
Other
Enumeration date
10/02/2019
Last updated
10/02/2019
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