Provider Demographics
NPI:1689805392
Name:MARTIN, VICKY (LPN)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:7152 EASTLAWN DR APT 4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4148
Mailing Address - Country:US
Mailing Address - Phone:513-562-0637
Mailing Address - Fax:
Practice Address - Street 1:7152 EASTLAWN DR APT 4
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-4148
Practice Address - Country:US
Practice Address - Phone:513-562-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134728164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse