Individual
MS. SANDRA L MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 NAVARRE PL, SUITE 6600, SOUTH BEND, IN 46601-1156
(574) 232-7227
(574) 232-2064
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001851A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000742868
BCBS
IN
05
—
200303930
—
IN
01
—
352145705
TAX ID
IN
Enumeration date
11/16/2005
Last updated
03/30/2021
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