Provider Demographics
NPI:1962409102
Name:MARTIN, LAUREEN J (RNP)
Entity type:Individual
Prefix:
First Name:LAUREEN
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19 FRIENDSHIP ST
Mailing Address - Street 2:SUITE130
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2200
Mailing Address - Country:US
Mailing Address - Phone:401-845-2113
Mailing Address - Fax:401-845-1529
Practice Address - Street 1:19 FRIENDSHIP ST
Practice Address - Street 2:SUITE130
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2200
Practice Address - Country:US
Practice Address - Phone:401-845-2113
Practice Address - Fax:401-845-1529
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RINPP26065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI26422-2OtherRI BC/BS
RI404617OtherRI BLUE CHIP
RILM15934Medicaid
RILM15934Medicaid
S11328Medicare UPIN