Provider Demographics
NPI:1356939979
Name:MARTIN, ROSA LYNN
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 WELLS RUN RD
Mailing Address - Street 2:
Mailing Address - City:CROWN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45623-3100
Mailing Address - Country:US
Mailing Address - Phone:740-853-1609
Mailing Address - Fax:
Practice Address - Street 1:868 WELLS RUN RD
Practice Address - Street 2:
Practice Address - City:CROWN CITY
Practice Address - State:OH
Practice Address - Zip Code:45623-3100
Practice Address - Country:US
Practice Address - Phone:740-853-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118011Medicaid