Provider Demographics
NPI:1457520348
Name:MARTIN, KRISTIN NICOLE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TURTLE CREEK CIR
Mailing Address - Street 2:SUITE F
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-8537
Mailing Address - Country:US
Mailing Address - Phone:419-825-5151
Mailing Address - Fax:
Practice Address - Street 1:1 TURTLE CREEK CIR
Practice Address - Street 2:SUITE F
Practice Address - City:SWANTON
Practice Address - State:OH
Practice Address - Zip Code:43558-8537
Practice Address - Country:US
Practice Address - Phone:419-825-5151
Practice Address - Fax:419-825-5901
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-09868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3104189Medicaid
OHMANP26281Medicare PIN
OH3104189Medicaid