Healthcare Provider Details

I. General information

NPI: 1942551387
Provider Name (Legal Business Name): FRANK ROGER PALIN N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2012
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 BREEZY LAKE DR
COVENTRY RI
02816-8019
US

IV. Provider business mailing address

47 BREEZY LAKE DR
COVENTRY RI
02816-8019
US

V. Phone/Fax

Practice location:
  • Phone: 401-828-3271
  • Fax:
Mailing address:
  • Phone: 401-828-3271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPP32681
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN22336
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number005004
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR51200
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN223336
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN32681
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: