Healthcare Provider Details

I. General information

NPI: 1356392807
Provider Name (Legal Business Name): PAMELA JOY BENNETT PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD BLDG D305
N.K RI
02852
US

IV. Provider business mailing address

1130 TEN ROD RD BLDG D305
NORTH KINGSTOWN RI
02852
US

V. Phone/Fax

Practice location:
  • Phone: 401-788-9573
  • Fax:
Mailing address:
  • Phone: 401-789-4013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN15994
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: