Provider Demographics
NPI:1588080121
Name:MARTIN, SUSAN ANITA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANITA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004884A363LF0000X, 363LP0808X
IN28143926A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health