Healthcare Provider Details

I. General information

NPI: 1427674449
Provider Name (Legal Business Name): NOURISHING HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 SOCKANOSSET CROSS RD STE 101
CRANSTON RI
02920-5559
US

IV. Provider business mailing address

125 MIDWAY RD APT 306
CRANSTON RI
02920-5760
US

V. Phone/Fax

Practice location:
  • Phone: 401-439-7116
  • Fax: 401-941-5128
Mailing address:
  • Phone: 401-439-7116
  • Fax: 401-941-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK BRANCATO
Title or Position: PRES.
Credential: LICAC
Phone: 401-439-7116