MEDICARE: LISA NATASHA MARTIN APN

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	163W00000X	Registered Nurse	28210911A	IN
2	363LF0000X	Family Nurse Practitioner	F04180350	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28210911A	OTHER	IL	REGISTERED NURSE LICENSE NUMBER

General Provider Information

NPI Number	:	1801430285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA NATASHA MARTIN APN

Provider Business Mailing Address
First Line	:	3145 SUMMERFIELD DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46214-1875
Country	:	US
Telephone Number	:	317-410-9978
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 EAGLE CREEK PKWY STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4692
Country	:	US
Telephone Number	:	317-410-9978
Fax Number	:

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

Provider Enumeration Date	:	10/29/2019
Last Update Date	:	10/29/2019

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Directions to “ LISA NATASHA MARTIN APN” Practice Location

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