Martin, Jacquelyn R

Martin, Jacquelyn R is an sole proprietor health care provider with primary practice located at 2651 E Discovery Pkwy , Bloomington IN 47408-9059. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Women's Health, Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife. Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife is her primary health care specialty. Martin, Jacquelyn R can be contacted via phone (812) 918-3400.

Contact Information

Primary practice address
2651 E Discovery Pkwy Bloomington IN 47408-9059
Phone: (812) 918-3400
Fax: (812) 918-5829
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Women's Health 363LW0102X 3015292 Kentucky
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X COA 07946 NM Ohio
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X 09000415A Indiana

Profile Details

NPI number 1942421672
LBN Legal business name Martin, Jacquelyn R
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 1st, 2007
Last updated Feb 9th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942421672 NPPES
Ohio Other 07946 OHIO LICENSE
Ohio MEDICAID 300002078 OHIO LICENSE
Ohio Other 090540823 OHIO LICENSE
Ohio MEDICAID 0099346 OHIO LICENSE

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