MEDICARE: MS. RENATTIE LENORA MARTIN NP-C

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	363L00000X	Nurse Practitioner	COA.10896	OH
2	363L00000X	Nurse Practitioner	95001616	CA
3	363LA2200X	Adult Health Nurse Practitioner	COA10896	OH
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN.CNP.10896	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01817209-DU5182	OTHER	CA	RAILROAD MEDICARE
3	P01817207-DU4034	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407182926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RENATTIE LENORA MARTIN NP-C

Provider Business Mailing Address
First Line	:	11000 OPTUM CIR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-2503
Country	:	US
Telephone Number	:	855-247-8374
Fax Number	:

Provider Business Practice Location Address
First Line	:	16616 BILTMORE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1442
Country	:	US
Telephone Number	:	216-798-7433
Fax Number	:

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

Provider Enumeration Date	:	10/19/2009
Last Update Date	:	04/05/2025

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