Healthcare Provider Details

I. General information

NPI: 1649452798
Provider Name (Legal Business Name): CORRINE E FISCHER RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 VETERANS MEMORIAL PKWY STE 10
EAST PROVIDENCE RI
02914-5300
US

IV. Provider business mailing address

98 10TH ST FL 2
PROVIDENCE RI
02906-2920
US

V. Phone/Fax

Practice location:
  • Phone: 401-413-0212
  • Fax:
Mailing address:
  • Phone: 401-413-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number2654
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number00650
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: