Healthcare Provider Details

I. General information

NPI: 1700719408
Provider Name (Legal Business Name): HALLIE N MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W GAMBIER ST
MOUNT VERNON OH
43050-2421
US

IV. Provider business mailing address

302 N MAIN ST APT 4
MOUNT VERNON OH
43050-2000
US

V. Phone/Fax

Practice location:
  • Phone: 740-403-3678
  • Fax:
Mailing address:
  • Phone: 740-403-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: