Healthcare Provider Details

I. General information

NPI: 1720005184
Provider Name (Legal Business Name): ANN Z. AVERY MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 MACARTHUR BLVD
COVENTRY RI
02816-7244
US

IV. Provider business mailing address

311 DORIC AVE
CRANSTON RI
02910-2903
US

V. Phone/Fax

Practice location:
  • Phone: 401-828-5335
  • Fax: 401-828-2914
Mailing address:
  • Phone: 401-467-9610
  • Fax: 401-467-9030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNPP27096
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: