Healthcare Provider Details

I. General information

NPI: 1013662840
Provider Name (Legal Business Name): NICOLE MARTIN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE STECHSCHULTE

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/20/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 HILTY DR
PANDORA OH
45877-9478
US

IV. Provider business mailing address

202 HILTY DR
PANDORA OH
45877-9478
US

V. Phone/Fax

Practice location:
  • Phone: 419-384-3251
  • Fax:
Mailing address:
  • Phone: 418-384-3251
  • Fax: 419-384-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: