Healthcare Provider Details

I. General information

NPI: 1447845037
Provider Name (Legal Business Name): RAEJEAN ELIZABETH SPARROW APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAEJEAN ELIZABETH PEARSE-THEROUX

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE
CRANSTON RI
02920-6068
US

IV. Provider business mailing address

PO BOX 202230
DALLAS TX
75320-2230
US

V. Phone/Fax

Practice location:
  • Phone: 401-943-1300
  • Fax: 401-946-8480
Mailing address:
  • Phone: 401-943-1300
  • Fax: 401-946-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02322
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02322
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: