MEDICARE: IN-HOME SUPPORT BY SHAWANA MARTIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse

General Provider Information

NPI Number	:	1003748518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN-HOME SUPPORT BY SHAWANA MARTIN

Provider Business Mailing Address
First Line	:	105 FERNDALE DR
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-3030
Country	:	US
Telephone Number	:	276-732-5667
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 FERNDALE DR
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-3030
Country	:	US
Telephone Number	:	276-732-5667
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SHAWANA S MARTIN
Credential	:	LPN
Telephone Number	:	276-732-5667

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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