Provider Demographics
NPI:1003851874
Name:MARTIN, RHEA MAE (WHNP)
Entity Type:Individual
Prefix:
First Name:RHEA
Middle Name:MAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:RHEA
Other - Middle Name:
Other - Last Name:VANDERBOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:709 PLAZA DRIVE SUITE #1
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304
Mailing Address - Country:US
Mailing Address - Phone:219-728-6091
Mailing Address - Fax:877-793-9750
Practice Address - Street 1:709 PLAZA DRIVE SUITE #1
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:219-728-6091
Practice Address - Fax:877-793-9750
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001625A363LW0102X
IN71001625B363LW0102X
IN28105259A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000480735OtherANTHEM PIN
IN200818070Medicaid
IN000000721669OtherANTHEM TRADITIONAL
IN200818070Medicaid
IN202790DDDDMedicare PIN