Healthcare Provider Details

I. General information

NPI: 1508720566
Provider Name (Legal Business Name): MARTHA DILLON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9081 N PUMPKINVINE RD
FAIRLAND IN
46126-9559
US

IV. Provider business mailing address

9081 N PUMPKINVINE RD
FAIRLAND IN
46126-9559
US

V. Phone/Fax

Practice location:
  • Phone: 317-448-6803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberIN28186072A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: