Provider Demographics
NPI:1437732047
Name:MARTIN, MERCEDES MARIE (STNA)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5522 AUTUMN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-4620
Mailing Address - Country:US
Mailing Address - Phone:937-469-0967
Mailing Address - Fax:
Practice Address - Street 1:5522 AUTUMN WOODS DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-4620
Practice Address - Country:US
Practice Address - Phone:937-469-0967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide