Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 09000372A | IN |
NPI | 1003499880 |
---|---|
Provider Name | Lori Ann Martin |
First Address | Goshen, IN 46526-9421 |
Second Address | Goshen, IN 46526-5909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2021 |
Last Update Date | 30/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09000372A | NURSE MIDWIFE LICENSE NUMBER (01) | IN |