Healthcare Provider Details

I. General information

NPI: 1245696491
Provider Name (Legal Business Name): CAROL ANNE MARTIN DNP,MS,CPNP,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 CAMBRIDGE ST
BOSTON MA
02134-2460
US

IV. Provider business mailing address

235 WELLESLEY ST
WESTON MA
02493-1571
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-8383
  • Fax: 617-254-0240
Mailing address:
  • Phone: 781-768-7000
  • Fax: 781-768-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LS0200X
TaxonomySchool Nurse Practitioner
License NumberRN197020
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: