Healthcare Provider Details

I. General information

NPI: 1548550171
Provider Name (Legal Business Name): TARAMARIE LILLIAN PIECYK RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE
CRANSTON RI
02920-6068
US

IV. Provider business mailing address

1150 RESERVOIR AVE STE 203
CRANSTON RI
02920-6043
US

V. Phone/Fax

Practice location:
  • Phone: 401-259-0340
  • Fax: 401-213-8538
Mailing address:
  • Phone: 401-259-0340
  • Fax: 401-213-8538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN279166
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN279166
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN45989
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN45989
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37588
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: