Provider Demographics
NPI:1033832076
Name:MARTIN, RENEE (MED)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8166 FITZGERALD DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-2031
Mailing Address - Country:US
Mailing Address - Phone:225-421-7006
Mailing Address - Fax:
Practice Address - Street 1:8166 FITZGERALD DR
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-2031
Practice Address - Country:US
Practice Address - Phone:225-421-7006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator