Individual
ARDELLA RAE MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CASE MANAGER
Contact information
Practice address
1632 BUSSERON ST, VINCENNES, IN 47591-5550
(812) 895-0644
Mailing address
1632 BUSSERON ST, P.O.BOX 1651, VINCENNES, IN 47591-5550
(812) 895-0644
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
PZ0691
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200377980A
—
IN
Enumeration date
03/19/2007
Last updated
09/25/2008
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