| NPI | 1134887102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN ANITA MARTIN Healthcare Provider/Owner 812-290-1611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2021-12-07 |