Healthcare Provider Details

I. General information

NPI: 1699740720
Provider Name (Legal Business Name): JOHN R. DUFRESNE N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 RESERVOIR AVE SUITE 100
CRANSTON RI
02920-6068
US

IV. Provider business mailing address

1150 RESERVOIR AVE SUITE 100
CRANSTON RI
02920-6068
US

V. Phone/Fax

Practice location:
  • Phone: 401-946-2400
  • Fax: 401-946-0107
Mailing address:
  • Phone: 401-946-2400
  • Fax: 401-946-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNPP37176
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37176
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: