Healthcare Provider Details

I. General information

NPI: 1003851874
Provider Name (Legal Business Name): RHEA MAE MARTIN WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RHEA VANDERBOK NP

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 PLAZA DRIVE SUITE #1
CHESTERTON IN
46304
US

IV. Provider business mailing address

709 PLAZA DRIVE SUITE #1
CHESTERTON IN
46304
US

V. Phone/Fax

Practice location:
  • Phone: 219-728-6091
  • Fax: 877-793-9750
Mailing address:
  • Phone: 219-728-6091
  • Fax: 877-793-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71001625A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71001625B
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number28105259A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: