MEDICARE: NANCY J MARTIN C.N.P.

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	NP04622	OH

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	:	1770543019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY J MARTIN C.N.P.

Provider Business Mailing Address
First Line	:	1069 KLOTZ RD STE A
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-4832
Country	:	US
Telephone Number	:	419-728-0110
Fax Number	:	419-728-0113

Provider Business Practice Location Address
First Line	:	1069 KLOTZ RD STE A
Second Line	:
City	:	BOWLING GREEN
State	:	OH
Zip	:	43402-4832
Country	:	US
Telephone Number	:	419-728-0110
Fax Number	:	419-728-0113

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	03/22/2016

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