Healthcare Provider Details

I. General information

NPI: 1639106545
Provider Name (Legal Business Name): PATRICIA M MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 DWIGHT ST
SPRINGFIELD MA
01107-1863
US

IV. Provider business mailing address

1777 DWIGHT ST
SPRINGFIELD MA
01107-1863
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-4478
  • Fax: 413-732-7059
Mailing address:
  • Phone: 413-732-4478
  • Fax: 413-732-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number118367
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: