Provider Demographics
NPI:1093443277
Name:WILSON, MARTINA MARIE
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1269 COUNTY ROAD 128
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8527
Mailing Address - Country:US
Mailing Address - Phone:740-533-9140
Mailing Address - Fax:
Practice Address - Street 1:1285 COUNTY ROAD 128
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-8527
Practice Address - Country:US
Practice Address - Phone:740-533-9140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant