Provider Demographics
NPI:1518626324
Name:MARTINEAU, EVA INORINE (CNM, LM)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:INORINE
Last Name:MARTINEAU
Suffix:
Gender:F
Credentials:CNM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 E 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2544
Mailing Address - Country:US
Mailing Address - Phone:646-342-0164
Mailing Address - Fax:
Practice Address - Street 1:1097 E 58TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2544
Practice Address - Country:US
Practice Address - Phone:646-342-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF002123-01367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife