Individual
MATHEW LEE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 502-4015
(765) 502-4016
Mailing address
PO BOX 781076, DETROIT, MI 48278-1008
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28247807A
IN
363L00000X
Nurse Practitioner
71017145A
IN
363LF0000X
Family Nurse Practitioner
Primary
71017145A
IN
Other
Enumeration date
05/30/2025
Last updated
11/14/2025
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