Provider Demographics
NPI:1417123902
Name:LEONARD, MARTHA ROSE (MSN, CPNP)
Entity type:Individual
Prefix:MS
First Name:MARTHA
Middle Name:ROSE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MSN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2126
Mailing Address - Country:US
Mailing Address - Phone:401-480-8275
Mailing Address - Fax:
Practice Address - Street 1:1 COMMERCE ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1186
Practice Address - Country:US
Practice Address - Phone:401-793-8484
Practice Address - Fax:401-793-8481
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00343363LP0200X, 363LP0200X, 363LP0200X
RIRN49501163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400177196Medicare PIN