MEDICARE: EDNALYNA MARTIN IBCLC, CD-L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	L-303380	NV
2	174N00000X	Lactation Consultant (Non-RN)	L-303380	GU
3	374J00000X	Doula		NV

General Provider Information

NPI Number	:	1407509441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNALYNA MARTIN IBCLC, CD-L

Provider Business Mailing Address
First Line	:	8635 W SAHARA AVE UNIT 4144
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5858
Country	:	US
Telephone Number	:	702-779-3121
Fax Number	:

Provider Business Practice Location Address
First Line	:	8635 W SAHARA AVE UNIT 4144
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-5858
Country	:	US
Telephone Number	:	702-779-3121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2022
Last Update Date	:	07/19/2025

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