Healthcare Provider Details

I. General information

NPI: 1831951995
Provider Name (Legal Business Name): BEYOND BEAUTY MEDSPA RI LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ROLFE SQ
CRANSTON RI
02910-3413
US

IV. Provider business mailing address

96 ROLFE SQ
CRANSTON RI
02910-3413
US

V. Phone/Fax

Practice location:
  • Phone: 401-236-7432
  • Fax:
Mailing address:
  • Phone: 401-236-7432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CORETTA JOSEPHINE ANTWI
Title or Position: CO OWNER
Credential: NP
Phone: 401-236-7432