Healthcare Provider Details

I. General information

NPI: 1245099340
Provider Name (Legal Business Name): BEATRICE AZAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE STE 203
CRANSTON RI
02920-6032
US

IV. Provider business mailing address

2 E RIDGE RD
N ATTLEBORO MA
02760-3596
US

V. Phone/Fax

Practice location:
  • Phone: 401-259-0340
  • Fax: 401-213-8538
Mailing address:
  • Phone: 540-429-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2316183
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2316183
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN04582
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: