Healthcare Provider Details

I. General information

NPI: 1801754999
Provider Name (Legal Business Name): GRACEFUL INNER LIGHT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 PARK AVE
CRANSTON RI
02910-2721
US

IV. Provider business mailing address

57 ROLFE SQ. P.O. BOX 100035
CRANSTON RI
02910-2721
US

V. Phone/Fax

Practice location:
  • Phone: 401-742-7037
  • Fax: 401-679-6533
Mailing address:
  • Phone: 401-742-1192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDA VASQUEZ
Title or Position: N.P/OWNER
Credential: N.P.
Phone: 401-742-7037