Healthcare Provider Details

I. General information

NPI: 1659103273
Provider Name (Legal Business Name): JARTU K WLEH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 CRANSTON ST
CRANSTON RI
02920-6758
US

IV. Provider business mailing address

156 CLART AVE
CRANSTON RI
02920-6758
US

V. Phone/Fax

Practice location:
  • Phone: 401-767-4100
  • Fax:
Mailing address:
  • Phone: 401-767-4100
  • Fax: 401-235-6896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN04169
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: