Provider Demographics
NPI:1477234714
Name:MARTIN, JANE W (CHC)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:W
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SHARP AVE
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-1136
Mailing Address - Country:US
Mailing Address - Phone:717-466-2853
Mailing Address - Fax:
Practice Address - Street 1:1020 SHARP AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1136
Practice Address - Country:US
Practice Address - Phone:717-466-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education