1871077511 NPI number — JANET REEVES MARTIN APRN

Table of content: JANET REEVES MARTIN APRN (NPI 1871077511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871077511 NPI number — JANET REEVES MARTIN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
JANET
Provider Middle Name:
REEVES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
JANET
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871077511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 PAVILLON DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT, KY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
41071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-652-7203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INFINITY DIALYSIS
Provider Second Line Business Practice Location Address:
4750 EAST GALBRAITH RD. SUITE 103
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
41017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-984-3500
Provider Business Practice Location Address Fax Number:
513-791-2151
Provider Enumeration Date:
09/19/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  3012567 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 3012567 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)