Healthcare Provider Details

I. General information

NPI: 1689699175
Provider Name (Legal Business Name): PATRICIA ANNE MARTINO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD STE 520
WARWICK RI
02886-1692
US

IV. Provider business mailing address

400 BALD HILL RD STE 520
WARWICK RI
02886-1692
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-8520
  • Fax: 401-793-8527
Mailing address:
  • Phone: 401-793-8520
  • Fax: 401-793-8527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCAPRN01034
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN25772
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberMM0924868
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN01034
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: