Individual
JEAN ELLEN MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2824 ELKHART RD, GOSHEN, IN 46526-1014
(574) 535-1700
(574) 535-1799
Mailing address
PO BOX 834, GOSHEN, IN 46527-0834
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71003218A
IN
363LF0000X
Family Nurse Practitioner
71003218A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200981470
—
IN
Enumeration date
01/11/2010
Last updated
05/03/2023
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