Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NR0400X | Rehabilitation Chiropractor | DCP00362 | RI |
Y | 363L00000X | Nurse Practitioner | 01338 | RI |
NPI | 1336299890 |
---|---|
Provider Name | Joyce M. Martin |
First Address | Cranston, RI 02920-7535 |
Second Address | Cranston, RI 02920 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 11/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U63117 | (02) | RI |