Healthcare Provider Details

I. General information

NPI: 1811053457
Provider Name (Legal Business Name): NANCY ELIZABETH WILSON LCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CASWELL STREET SUITE 1100
NARRAGANSETT RI
02882-3385
US

IV. Provider business mailing address

28 CASWELL STREET SUITE 1100
NARRAGANSETT RI
02882-3385
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-1670
  • Fax: 401-789-6990
Mailing address:
  • Phone: 401-783-1670
  • Fax: 401-789-6990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT00064
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: