Healthcare Provider Details

I. General information

NPI: 1639736002
Provider Name (Legal Business Name): JENNIFER OLIVEIRA-BENTO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 BAY VIEW AVE
BRISTOL RI
02809-3421
US

IV. Provider business mailing address

72 BAY VIEW AVE
BRISTOL RI
02809-3421
US

V. Phone/Fax

Practice location:
  • Phone: 401-302-0246
  • Fax:
Mailing address:
  • Phone: 401-302-0246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN48453
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: