Healthcare Provider Details

I. General information

NPI: 1134043946
Provider Name (Legal Business Name): NORTHSTAR MEDICAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 PLAINFIELD PIKE
COVENTRY RI
02827-1908
US

IV. Provider business mailing address

13 AIRPORT RD STE 1014
WESTERLY RI
02891-3401
US

V. Phone/Fax

Practice location:
  • Phone: 401-601-6544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: REBECCA BERRY
Title or Position: PARTNER
Credential: FNP-C
Phone: 401-601-6544