Healthcare Provider Details

I. General information

NPI: 1295913739
Provider Name (Legal Business Name): MARILYN J MARTIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 RAILROAD AVE
WARREN RI
02885-3206
US

IV. Provider business mailing address

25 RAILROAD AVE
WARREN RI
02885-3206
US

V. Phone/Fax

Practice location:
  • Phone: 401-247-4278
  • Fax: 401-247-4569
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN32568
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: