Provider Demographics
NPI:1831886324
Name:MARTIN, JERMAINE AKEEM (LPN)
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:AKEEM
Last Name:MARTIN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20701 SELFRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-7045
Mailing Address - Country:US
Mailing Address - Phone:216-551-6112
Mailing Address - Fax:
Practice Address - Street 1:20701 SELFRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:HIGHLAND HILLS
Practice Address - State:OH
Practice Address - Zip Code:44122-7045
Practice Address - Country:US
Practice Address - Phone:216-551-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.147445.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse