Provider Demographics
NPI:1699583005
Name:MARTIN, MARIAH RENEE (RN, BSN)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:RENEE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 W STATE ROAD 58
Mailing Address - Street 2:
Mailing Address - City:FREETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47235-9754
Mailing Address - Country:US
Mailing Address - Phone:812-767-8181
Mailing Address - Fax:
Practice Address - Street 1:2400 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5351
Practice Address - Country:US
Practice Address - Phone:812-376-5278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28281485C163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency