Healthcare Provider Details

I. General information

NPI: 1275501611
Provider Name (Legal Business Name): JANIS M DENUCCIO RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 NEW LONDON AVE
CRANSTON RI
02920-3035
US

IV. Provider business mailing address

1090 NEW LONDON AVE
CRANSTON RI
02920-3035
US

V. Phone/Fax

Practice location:
  • Phone: 401-463-5778
  • Fax: 401-463-3582
Mailing address:
  • Phone: 401-463-5778
  • Fax: 401-463-3582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN25776
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: