Healthcare Provider Details

I. General information

NPI: 1538797527
Provider Name (Legal Business Name): NICOLE ANN OKSANISH FNP-C, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE ANN CHADBOURNE RN

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 WASHINGTON STREE CNEMG PRIMARY CARE OF COVENTRY
COVENTRY RI
02816
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-2772
  • Fax: 401-821-5260
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN04216
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2267506
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN2267506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: