Provider Demographics
NPI:1669989380
Name:MARTENEY, MANDY ALLISON (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:ALLISON
Last Name:MARTENEY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 ABERDEEN DR STE A
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1737
Mailing Address - Country:US
Mailing Address - Phone:814-445-3535
Mailing Address - Fax:814-445-3245
Practice Address - Street 1:600 ABERDEEN DR STE A
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1737
Practice Address - Country:US
Practice Address - Phone:814-445-3535
Practice Address - Fax:814-445-3245
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN684452163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse