Provider Demographics
NPI:1942062666
Name:MARTIN, TAMARA MONIQUE
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:MONIQUE
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 1:6891 BARTLETT RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2905
Mailing Address - Country:US
Mailing Address - Phone:614-702-0702
Mailing Address - Fax:
Practice Address - Street 1:6891 BARTLETT RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2905
Practice Address - Country:US
Practice Address - Phone:614-702-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126800000X
OHRN.502718163WW0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No126800000XDental ProvidersDental Assistant
No163WW0000XNursing Service ProvidersRegistered NurseWound Care