Provider Demographics
NPI:1629675707
Name:NECKLACE-MERIDA, MARTINA
Entity Type:Individual
Prefix:MS
First Name:MARTINA
Middle Name:
Last Name:NECKLACE-MERIDA
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 1:7881 ARROWROOT CT
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-4830
Mailing Address - Country:US
Mailing Address - Phone:614-208-3263
Mailing Address - Fax:
Practice Address - Street 1:272 ESSEX PL
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7561
Practice Address - Country:US
Practice Address - Phone:740-644-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide