Healthcare Provider Details

I. General information

NPI: 1881336683
Provider Name (Legal Business Name): JUSTIN MALETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BUTTONWOODS AVE
WARWICK RI
02886-7541
US

IV. Provider business mailing address

311 DORIC AVE
CRANSTON RI
02910-2903
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-9090
  • Fax: 401-732-2970
Mailing address:
  • Phone: 401-467-9610
  • Fax: 401-467-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN03116
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2308924
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: