Provider Demographics
NPI:1134887102
Name:SUSAN A. MARTIN NP LLC
Entity type:Organization
Organization Name:SUSAN A. MARTIN NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTHCARE PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:812-290-1611
Mailing Address - Street 1:7655 STATE ROAD 48
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IN
Mailing Address - Zip Code:47001-8987
Mailing Address - Country:US
Mailing Address - Phone:812-290-1611
Mailing Address - Fax:
Practice Address - Street 1:PINE KNOLL ASSISTED LIVING
Practice Address - Street 2:607 WILSON CREEK RD.
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025
Practice Address - Country:US
Practice Address - Phone:812-537-4422
Practice Address - Fax:812-537-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty