Healthcare Provider Details

I. General information

NPI: 1710264015
Provider Name (Legal Business Name): DIANE LYNNE DEPASQUALE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SOUTH COUNTY TRAIL SUITE 1A
EAST GREENWICH RI
02818
US

IV. Provider business mailing address

455 TOLL GATE RD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-7290
  • Fax: 401-921-6194
Mailing address:
  • Phone: 401-273-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00686
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: