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General NPI Number Information
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NPI Number | 1083811376
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Entity Type | Individual
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Provider Name | MARTHA J MANCE NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 100 HIGHLAND AVE STE 302
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City | PROVIDENCE
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State | RI
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Zip | 02906-2753
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Country | US
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Telephone | 401-633-1100
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Fax | 401-633-0047
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Provider Business Mailing Address
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Address Line | 1 SHADOWBROOK LN
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City | SOUTH EASTON
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State | MA
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Zip | 02375-1078
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Country | US
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Telephone | 508-230-7288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN00199
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License Number State | RI
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