Healthcare Provider Details

I. General information

NPI: 1225606247
Provider Name (Legal Business Name): TESS MARTENS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE UNIT 324
WAKEFIELD RI
02879-4253
US

IV. Provider business mailing address

169 FRANKLIN ST APT 1
BRISTOL RI
02809-3375
US

V. Phone/Fax

Practice location:
  • Phone: 401-788-8780
  • Fax: 401-788-8787
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02630
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02630
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberAPRN02630
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: