Individual
KELLY A MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4720
(860) 358-6271
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-4720
(860) 358-6271
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
004959
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004959
CT LIC #
CT
Enumeration date
06/27/2012
Last updated
06/27/2012
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