Healthcare Provider Details

I. General information

NPI: 1659743979
Provider Name (Legal Business Name): DANNON RAE MARTIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANNON RAE MARTIN WALKER PA

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RICHARD GORDON HATCHER BLVD
GARY IN
46402-6001
US

IV. Provider business mailing address

600 RICHARD GORDON HATCHER BLVD
GARY IN
46402-6001
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-4000
  • Fax:
Mailing address:
  • Phone: 773-233-8524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005720
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002514B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: