Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 70000054A | IN |
NPI | 1003918715 |
---|---|
Provider Name | Caroline Ruth Martin |
First Address | Indianapolis, IN 46266-4056 |
Second Address | Indianapolis, IN 46227-8590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 14/12/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P03314 | (02) | IN |