MEDICARE: EDNA ILLEANA GOMEZ DUENAS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN05040	RI
2	363L00000X	Nurse Practitioner	RN2324655	MA

General Provider Information

NPI Number	:	1316803075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA ILLEANA GOMEZ DUENAS FNP-C

Provider Business Mailing Address
First Line	:	35 PEMBROKE AVE APT 3R
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-2934
Country	:	US
Telephone Number	:	760-625-8508
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 PEMBROKE AVE APT 3R
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02908-2934
Country	:	US
Telephone Number	:	760-625-8508
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	03/06/2026

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