Healthcare Provider Details

I. General information

NPI: 1346256146
Provider Name (Legal Business Name): MARJORIE BERNICE KEEFE-CANETTI NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BUTTERFIELD ROAD POTTER BUILDING
KINGSTON RI
02881
US

IV. Provider business mailing address

6 BUTTERFIELD ROAD POTTER BUILDING
KINGSTON RI
02881
US

V. Phone/Fax

Practice location:
  • Phone: 401-874-4758
  • Fax: 401-874-2586
Mailing address:
  • Phone: 401-874-4758
  • Fax: 401-874-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25688
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: