Individual
JEREMIAH LEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1418 COLLEGE DR, MOUNT CARMEL, IL 62863-2638
(618) 262-8621
Mailing address
323 E 5TH ST, MOUNT CARMEL, IL 62863-2123
(618) 450-2480
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209007481
IL
Other
Enumeration date
03/03/2009
Last updated
03/03/2009
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