Provider Demographics
NPI:1497773071
Name:MARTENEY, CAROL A (CRNA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:MARTENEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711131
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-1131
Mailing Address - Country:US
Mailing Address - Phone:937-293-0247
Mailing Address - Fax:
Practice Address - Street 1:405 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4720
Practice Address - Country:US
Practice Address - Phone:937-723-5863
Practice Address - Fax:937-723-5109
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV017996367500000X
OHCOA.04237-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0856542Medicaid
WV2603263000Medicaid
OHP00789301OtherRAILROAD MEDICARE - MHCPI
OH0856542Medicaid
WVMA8228735Medicare ID - Type UnspecifiedMEDICARE