Healthcare Provider Details

I. General information

NPI: 1962169649
Provider Name (Legal Business Name): DEZARAE THEREZE ROSSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 JOHNSON BLVD
COVENTRY RI
02816-6019
US

IV. Provider business mailing address

36 JOHNSON BLVD
COVENTRY RI
02816-6019
US

V. Phone/Fax

Practice location:
  • Phone: 401-447-6723
  • Fax:
Mailing address:
  • Phone: 401-447-6723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN62416
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN03691
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: