Provider Demographics
NPI:1063601136
Name:BROUGH, MARTHA (RN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:BROUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CLINTON ST
Mailing Address - Street 2:THUNDERMIST HEALTH CENTER
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-3207
Mailing Address - Country:US
Mailing Address - Phone:401-767-4100
Mailing Address - Fax:401-235-6899
Practice Address - Street 1:450 CLINTON ST
Practice Address - Street 2:THUNDERMIST HEALTH CENTER
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-3207
Practice Address - Country:US
Practice Address - Phone:401-767-4100
Practice Address - Fax:401-235-6899
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2009-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
RIRN21245163WC1500X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator