Healthcare Provider Details

I. General information

NPI: 1417781535
Provider Name (Legal Business Name): TANIA M MARTIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6148 E 13TH ST
INDIANAPOLIS IN
46219-3320
US

IV. Provider business mailing address

6148 E 13TH ST
INDIANAPOLIS IN
46219-3320
US

V. Phone/Fax

Practice location:
  • Phone: 765-631-7485
  • Fax:
Mailing address:
  • Phone: 765-631-7485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: TIMELESS REFLECTION M MARTIN
Title or Position: CEO
Credential:
Phone: 765-631-7485