Provider Demographics
NPI:1114329992
Name:MARTEINA, JILLYVETTE MAREIA (HOME HEALTH AIDE/CST)
Entity Type:Individual
Prefix:MS
First Name:JILLYVETTE
Middle Name:MAREIA
Last Name:MARTEINA
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE/CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 DEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2210
Mailing Address - Country:US
Mailing Address - Phone:614-432-9215
Mailing Address - Fax:
Practice Address - Street 1:2215 DEEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2210
Practice Address - Country:US
Practice Address - Phone:614-432-9215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3140318Medicaid