Provider Demographics
NPI:1174067870
Name:CHWASCINSKA-SZAREK, MARTINA HALLEY (CNM)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:HALLEY
Last Name:CHWASCINSKA-SZAREK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MARTINA
Other - Middle Name:
Other - Last Name:SZAREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:595C DOLORES ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1564
Mailing Address - Country:US
Mailing Address - Phone:917-783-8323
Mailing Address - Fax:
Practice Address - Street 1:1505 SOQUEL DR STE 5A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1716
Practice Address - Country:US
Practice Address - Phone:831-465-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95042001163W00000X
CA235823367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse