Healthcare Provider Details

I. General information

NPI: 1356484265
Provider Name (Legal Business Name): MARY JANE T CREELY MS, RN, PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 JOHNNY CAKE HILL RD
MIDDLETOWN RI
02842-5674
US

IV. Provider business mailing address

127 JOHNNY CAKE HILL RD
MIDDLETOWN RI
02842-5674
US

V. Phone/Fax

Practice location:
  • Phone: 401-846-1213
  • Fax: 401-848-9151
Mailing address:
  • Phone: 401-846-1213
  • Fax: 401-848-9151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPNS00002
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: