Healthcare Provider Details

I. General information

NPI: 1336299890
Provider Name (Legal Business Name): JOYCE M. MARTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 CRANSTON STREET
CRANSTON RI
02920
US

IV. Provider business mailing address

1040 CRANSTON ST
CRANSTON RI
02920-7535
US

V. Phone/Fax

Practice location:
  • Phone: 401-942-0600
  • Fax: 401-943-0604
Mailing address:
  • Phone: 401-942-0600
  • Fax: 401-943-0604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8390
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDCP00362
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN243505
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number01338
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: