Healthcare Provider Details

I. General information

NPI: 1407509441
Provider Name (Legal Business Name): EDNALYNA MARTIN IBCLC, CD-L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 07/19/2025
Certification Date: 07/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W SAHARA AVE UNIT 4144
LAS VEGAS NV
89117-5858
US

IV. Provider business mailing address

8635 W SAHARA AVE UNIT 4144
LAS VEGAS NV
89117-5858
US

V. Phone/Fax

Practice location:
  • Phone: 702-779-3121
  • Fax:
Mailing address:
  • Phone: 702-779-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-303380
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-303380
License Number StateGU
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: