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General NPI Number Information
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NPI Number | 1699583005
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Entity Type | Individual
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Provider Name | MARIAH RENEE MARTIN RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 2400 17TH ST
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City | COLUMBUS
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State | IN
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Zip | 47201-5351
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Country | US
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Telephone | 812-376-5278
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Fax |
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Provider Business Mailing Address
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Address Line | 4733 W STATE ROAD 58
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City | FREETOWN
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State | IN
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Zip | 47235-9754
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Country | US
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Telephone | 812-767-8181
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 28281485C
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License Number State | IN
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