Individual
MRS. MICAELLE MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
36 GARDNER ST, EAST WINDSOR, CT 06088-9675
(860) 292-4000
(860) 292-8326
Mailing address
36 GARDNER ST, EAST WINDSOR, CT 06088-9675
(860) 292-4000
(860) 292-8326
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
195552
MA
363LP0200X
Pediatric Nurse Practitioner
006123
CT
Other
Enumeration date
02/19/2009
Last updated
06/19/2015
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