Healthcare Provider Details

I. General information

NPI: 1770731820
Provider Name (Legal Business Name): ANNE T MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE T CHESSER

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 02/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N ILLINOIS ST SUITE 465
CARMEL IN
46032-3010
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 130 PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-817-0010
  • Fax: 317-817-0012
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28139087A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71002731
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: