MEDICARE: ANTOINETTE J LAMAR-MARTINA

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0038072	OH

General Provider Information

NPI Number	:	1265248660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE J LAMAR-MARTINA

Provider Business Mailing Address
First Line	:	1909 W 54TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3256
Country	:	US
Telephone Number	:	216-540-4783
Fax Number	:

Provider Business Practice Location Address
First Line	:	1909 W 54TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3256
Country	:	US
Telephone Number	:	216-540-4783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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