Healthcare Provider Details

I. General information

NPI: 1528185840
Provider Name (Legal Business Name): GINA COZZOLINO MAYO MS, RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4099 OLD POST RD
CHARLESTOWN RI
02813-2553
US

IV. Provider business mailing address

PO BOX 910
CHARLESTOWN RI
02813-0901
US

V. Phone/Fax

Practice location:
  • Phone: 401-364-0770
  • Fax: 401-364-7694
Mailing address:
  • Phone: 401-348-4074
  • Fax: 401-364-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN01206
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCNPP37401
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN01206
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: