MEDICARE: CAROLINE RUTH MARTIN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	70000054A	IN

General Provider Information

NPI Number	:	1003918715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE RUTH MARTIN NP

Provider Business Mailing Address
First Line	:	PO BOX 664056
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46266-4056
Country	:	US
Telephone Number	:	317-780-3333
Fax Number	:	317-780-3345

Provider Business Practice Location Address
First Line	:	610 E SOUTHPORT RD
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-8590
Country	:	US
Telephone Number	:	317-781-4588
Fax Number	:	317-782-4885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	12/14/2009

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Directions to “ CAROLINE RUTH MARTIN NP” Practice Location

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