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General NPI Number Information
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NPI Number | 1770608549
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Entity Type | Individual
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Provider Name | ANNE THERESE MARTIN NP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 100 LOURDES HALL
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City | NOTRE DAME
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State | IN
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Zip | 46556-5036
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Country | US
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Telephone | 574-284-5699
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Fax | 574-284-5807
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Provider Business Mailing Address
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Address Line | 1606 TUDOR LN
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City | SOUTH BEND
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State | IN
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Zip | 46614-2355
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Country | US
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Telephone | 574-231-8314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71000143A
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License Number State | IN
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