Provider Demographics
NPI:1922548536
Name:MARTIN, JENNIFER LUCILLE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LUCILLE
Last Name:MARTIN
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 1:3348 TRAIL ON RD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1146
Mailing Address - Country:US
Mailing Address - Phone:937-672-4382
Mailing Address - Fax:
Practice Address - Street 1:3348 TRAIL ON RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1146
Practice Address - Country:US
Practice Address - Phone:937-672-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant