Provider Demographics
NPI:1184222176
Name:MARTIN, DANA MARIE
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:MARIE
Last Name:MARTIN
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 1:5268 LITTLE TURTLE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-8702
Mailing Address - Country:US
Mailing Address - Phone:513-254-1701
Mailing Address - Fax:
Practice Address - Street 1:5268 LITTLE TURTLE DR
Practice Address - Street 2:
Practice Address - City:SOUTH LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45065-8702
Practice Address - Country:US
Practice Address - Phone:513-254-1701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM8301288Medicaid