MEDICARE: MAMIE L MARTIN APRN-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
1	363LF0000X	Family Nurse Practitioner	NP07137	OH

General Provider Information

NPI Number	:	1932108669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMIE L MARTIN APRN-CNP

Provider Business Mailing Address
First Line	:	700 ACKERMAN RD STE 2120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-1559
Country	:	US
Telephone Number	:	614-257-3760
Fax Number	:

Provider Business Practice Location Address
First Line	:	1492 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1546
Country	:	US
Telephone Number	:	614-257-3760
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/29/2026

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