Provider Demographics
NPI:1003918715
Name:MARTIN, CAROLINE RUTH (NP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:RUTH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 664056
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-4056
Mailing Address - Country:US
Mailing Address - Phone:317-780-3333
Mailing Address - Fax:317-780-3345
Practice Address - Street 1:610 E SOUTHPORT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8590
Practice Address - Country:US
Practice Address - Phone:317-781-4588
Practice Address - Fax:317-782-4885
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000054A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP03314Medicare UPIN
IN677340JMedicare ID - Type Unspecified