Provider Demographics
NPI:1770608549
Name:MARTIN, ANNE THERESE (NP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:THERESE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 TUDOR LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2355
Mailing Address - Country:US
Mailing Address - Phone:574-231-8314
Mailing Address - Fax:
Practice Address - Street 1:100 LOURDES HALL
Practice Address - Street 2:
Practice Address - City:NOTRE DAME
Practice Address - State:IN
Practice Address - Zip Code:46556-5036
Practice Address - Country:US
Practice Address - Phone:574-284-5699
Practice Address - Fax:574-284-5807
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000143A363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology