Provider Demographics
NPI:1245696491
Name:MARTIN, CAROL ANNE (DNP,MS,CPNP,RN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:DNP,MS,CPNP,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WELLESLEY ST
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1571
Mailing Address - Country:US
Mailing Address - Phone:781-768-7000
Mailing Address - Fax:781-768-7089
Practice Address - Street 1:617 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2460
Practice Address - Country:US
Practice Address - Phone:617-254-8383
Practice Address - Fax:617-254-0240
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN197020363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool