Provider Demographics
NPI:1861603896
Name:RICHARDS, MARTINA (APRN, BC)
Entity type:Individual
Prefix:MRS
First Name:MARTINA
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1078 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1673
Mailing Address - Country:US
Mailing Address - Phone:781-283-2810
Mailing Address - Fax:781-283-3693
Practice Address - Street 1:106 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-8268
Practice Address - Country:US
Practice Address - Phone:781-283-2810
Practice Address - Fax:781-283-3693
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213325363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA213325OtherNURSING LICENSE