Healthcare Provider Details

I. General information

NPI: 1366488264
Provider Name (Legal Business Name): MELANIE KOEHLER APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 SOCKANOSSET CROSS RD STE 110
CRANSTON RI
02920-5558
US

IV. Provider business mailing address

75 SOCKANOSSET CROSS RD STE 110
CRANSTON RI
02920-5558
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-6400
  • Fax: 401-946-6406
Mailing address:
  • Phone: 401-946-6400
  • Fax: 401-946-6406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberPPNS00016
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPPNS00016
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: