MEDICARE: MISS CARREESE L MARTIN RN

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	163W00000X	Registered Nurse	RN311571	OH
2	163WC0200X	Critical Care Medicine Registered Nurse	RN311571	OH

General Provider Information

NPI Number	:	1649507161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CARREESE L MARTIN RN

Provider Business Mailing Address
First Line	:	3776 HILLBROOK RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3762
Country	:	US
Telephone Number	:	216-371-1468
Fax Number	:

Provider Business Practice Location Address
First Line	:	3776 HILLBROOK RD
Second Line	:
City	:	UNIVERSITY HEIGHTS
State	:	OH
Zip	:	44118-3762
Country	:	US
Telephone Number	:	216-371-1468
Fax Number	:

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

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	11/04/2009

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