Healthcare Provider Details

I. General information

NPI: 1699068551
Provider Name (Legal Business Name): GAIL E AUDETTE R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COMMERCE ST INTERNAL MEDICINE
LINCOLN RI
02865-1168
US

IV. Provider business mailing address

1 COMMERCE ST INTERNAL MEDICINE
LINCOLN RI
02865-1168
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-8500
  • Fax: 401-793-8511
Mailing address:
  • Phone: 401-793-8500
  • Fax: 401-793-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN21956
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: