Healthcare Provider Details

I. General information

NPI: 1851370498
Provider Name (Legal Business Name): CARLINE LECLERC FLEIG RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 OLD FERRY RD
BRISTOL RI
02809-2938
US

IV. Provider business mailing address

1050 MIDDLE RD
PORTSMOUTH RI
02871-2247
US

V. Phone/Fax

Practice location:
  • Phone: 401-254-3156
  • Fax: 401-254-3305
Mailing address:
  • Phone: 401-683-0671
  • Fax: 401-254-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP34592
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: