| Doctor Name: | MRS. MICAELLE MARTIN |
| NPI Number: | 1154560852 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 006123 |
| Business Practice Address: | 36 Gardner St East Windsor, CT - 060889675 |
| Business Phone Number: | 8602924000 |
| Business Fax Number: | 8602928326 |
| Mailing Address: | 36 Gardner St, EAST WINDSOR |
| State: | CT |
| Postal Code: | 060889675 |
| Phone Number: | 8602924000 |
| Fax Number: | 8602928326 |
| NPI Enumeration Date: | 02/19/2009 |
| NPI Last Update Date: | 06/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 006123 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |