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General NPI Number Information
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NPI Number | 1881336683
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Entity Type | Individual
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Provider Name | JUSTIN MALETTE
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Gender | Male
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Dates
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Enumeration Date | 04/12/2022
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Last Update Date | 06/02/2022
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Provider Practice Location Address
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Address Line | 727 EAST AVE
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City | PAWTUCKET
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State | RI
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Zip | 02860-6185
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Country | US
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Telephone | 401-725-6190
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Fax |
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Provider Business Mailing Address
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Address Line | 14 NANCY RD APT 5
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City | SOUTH EASTON
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State | MA
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Zip | 02375-1626
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Country | US
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Telephone | 508-245-8067
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN03116
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 00000
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License Number State | RI
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