Healthcare Provider Details

I. General information

NPI: 1457446593
Provider Name (Legal Business Name): PATRICIA A PETITPAS APRN/PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 RESERVOIR AVE
CRANSTON RI
02910-4453
US

IV. Provider business mailing address

60 METROPOLITAN DRIVE
WARWICK RI
02886-7922
US

V. Phone/Fax

Practice location:
  • Phone: 401-944-0194
  • Fax: 401-944-0196
Mailing address:
  • Phone: 401-738-1820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCDP00043
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN22224
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPPNS00064
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN22224
License Number StateRI
# 5
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPPNS00064
License Number StateRI
# 6
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberLCDP00043
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: