MEDICARE: LINDA JEAN MARTIN

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1992399901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JEAN MARTIN

Provider Business Mailing Address
First Line	:	1050 FAIRWAY DR
Second Line	:
City	:	LAKE ISABELLA
State	:	MI
Zip	:	48893-9336
Country	:	US
Telephone Number	:	989-289-2771
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 FAIRWAY DR
Second Line	:
City	:	LAKE ISABELLA
State	:	MI
Zip	:	48893-9336
Country	:	US
Telephone Number	:	989-289-2771
Fax Number	:

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

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	02/22/2021

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Directions to “ LINDA JEAN MARTIN ” Practice Location

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