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Individual
JACQUELYN R MARTIN
Active
Individual
JACQUELYN R MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
3015292
KY
367A00000X
Advanced Practice Midwife
Primary
09000415A
IN
367A00000X
Advanced Practice Midwife
COA 07946 NM
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0099346
—
OH
01
—
07946
OHIO LICENSE
OH
01
—
090540823
MEDICARE
IN
05
—
300002078
—
IN
Enumeration date
05/01/2007
Last updated
02/09/2023
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