Healthcare Provider Details

I. General information

NPI: 1982152575
Provider Name (Legal Business Name): RAIMECA MARTIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2016
Last Update Date: 09/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 E MAIN ST
COLUMBUS OH
43213-2503
US

IV. Provider business mailing address

PO BOX 32315
COLUMBUS OH
43232-0315
US

V. Phone/Fax

Practice location:
  • Phone: 614-328-5555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18953
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: