Healthcare Provider Details

I. General information

NPI: 1487516969
Provider Name (Legal Business Name): PORTIA SALTIBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 HOWARD AVE
CRANSTON RI
02920-8403
US

IV. Provider business mailing address

26 FAIRFIELD AVE
PROVIDENCE RI
02909-4106
US

V. Phone/Fax

Practice location:
  • Phone: 401-462-3383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN25311
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: