Individual
IVORIE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5658 YORKTOWN LN, AUSTINTOWN, OH 44515-1922
(330) 397-9078
Mailing address
5658 YORKTOWN LN, AUSTINTOWN, OH 44515-1922
(330) 397-9078
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.110385.MEDS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LPN.110385.MEDS
—
OH
Enumeration date
01/08/2019
Last updated
01/08/2019
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