Healthcare Provider Details

I. General information

NPI: 1134097835
Provider Name (Legal Business Name): LEAH ANDRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 ARBUTUS TRL
COVENTRY RI
02816-6463
US

IV. Provider business mailing address

3 ARBUTUS TRL
COVENTRY RI
02816-6463
US

V. Phone/Fax

Practice location:
  • Phone: 401-500-5557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN79833
License Number StateRI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: