Individual
JACQUELINE C MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
26 CHAMBERLAIN HWY, KENSINGTON, CT 06037-1921
(860) 893-0040
(860) 893-0046
Mailing address
26 CHAMBERLAIN HWY, KENSINGTON, CT 06037-1921
(860) 893-0040
(860) 893-0046
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
005215
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008042980
—
CT
Enumeration date
11/10/2012
Last updated
05/26/2021
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