=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770390387
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENRX, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2024
-----------------------------------------------------
Last Update Date | 12/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 650 OAKLAWN AVE
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02920-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-942-0600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 650 OAKLAWN AVE
-----------------------------------------------------
City | CRANSTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02920-2811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-265-6160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOYCE MARTIN
-----------------------------------------------------
Credential | DC, APRN
-----------------------------------------------------
Telephone | 401-265-6160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------