Healthcare Provider Details

I. General information

NPI: 1154653541
Provider Name (Legal Business Name): DIABETES EDUCATION PARTNERS OF RHODE ISLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 STONY BROOK DR
CRANSTON RI
02920-2131
US

IV. Provider business mailing address

PO BOX 41653
PROVIDENCE RI
02940-1653
US

V. Phone/Fax

Practice location:
  • Phone: 401-524-2481
  • Fax:
Mailing address:
  • Phone: 401-524-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: DIANA MERCURIO
Title or Position: CHAIR PERSON
Credential: CDOE
Phone: 401-524-2481