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NPI Code Detail

MEDICARE: TYRA DEJEAN MARTINEAR CNP

MEDICARE: TYRA DEJEAN MARTINEAR CNP
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
1363LF0000XFamily Nurse Practitioner323828OH
2363L00000XNurse PractitionerAPRN.CNP.18355OH

General Provider Information

NPI Number : 1447621941
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYRA DEJEAN MARTINEAR CNP
Provider Business Mailing Address
First Line : 1050 FORRER BLVD STE 250
Second Line :
City : KETTERING
State : OH
Zip : 45420-3640
Country : US
Telephone Number : 800-986-4801
Fax Number : 937-684-9990
Provider Business Practice Location Address
First Line : 1050 FORRER BLVD STE 250
Second Line :
City : KETTERING
State : OH
Zip : 45420-3640
Country : US
Telephone Number : 800-986-4801
Fax Number : 937-684-9990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2015
Last Update Date : 08/11/2025

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Directions to “ TYRA DEJEAN MARTINEAR CNP” Practice Location

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