Provider Demographics
NPI:1285860668
Name:MARTIN, IVA FU (FNP-BC)
Entity type:Individual
Prefix:
First Name:IVA
Middle Name:FU
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 E STATE HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-6807
Mailing Address - Country:US
Mailing Address - Phone:812-219-6354
Mailing Address - Fax:
Practice Address - Street 1:2542 E STATE HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-6807
Practice Address - Country:US
Practice Address - Phone:812-219-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-30
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28130723A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily