Provider Demographics
NPI:1871751263
Name:MARTINE, JEANNE LORRAINE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:LORRAINE
Last Name:MARTINE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 LORRAINE DR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1414
Mailing Address - Country:US
Mailing Address - Phone:201-573-1480
Mailing Address - Fax:
Practice Address - Street 1:ONE SOUTH BROADWAY
Practice Address - Street 2:GRAHAM WINDHAM
Practice Address - City:HASTINGS-ON-HUDSON
Practice Address - State:NJ
Practice Address - Zip Code:10706
Practice Address - Country:US
Practice Address - Phone:914-478-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN03760800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily