Healthcare Provider Details

I. General information

NPI: 1174815013
Provider Name (Legal Business Name): KATHERINE M BUCCI RN, MPH, CDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 DEXTER SAUNDERS RD
GLOCESTER RI
02857-2600
US

IV. Provider business mailing address

610 WATERMAN AVENUE
EAST PROVIDENCE RI
02914-2427
US

V. Phone/Fax

Practice location:
  • Phone: 401-595-5313
  • Fax:
Mailing address:
  • Phone: 401-595-5313
  • Fax: 401-435-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN18144
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: