Provider Demographics
NPI:1407509441
Name:MARTIN, EDNALYNA (IBCLC, CD-L)
Entity Type:Individual
Prefix:
First Name:EDNALYNA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:IBCLC, CD-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8179 PALACE MONACO AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2569
Mailing Address - Country:US
Mailing Address - Phone:725-260-4911
Mailing Address - Fax:
Practice Address - Street 1:8179 PALACE MONACO AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2569
Practice Address - Country:US
Practice Address - Phone:725-260-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVL-303380174N00000X
GUL-303380174N00000X
NV374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN