Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 28165946 | IN |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 71002131 | IN |
NPI | 1215010806 |
---|---|
Provider Name | Mary C Martin-Hemphill |
First Address | South Bend, IN 46660-6309 |
Second Address | Mishawaka, IN 46545-1469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 08/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200816510 | (05) | IN |