Healthcare Provider Details

I. General information

NPI: 1235764754
Provider Name (Legal Business Name): COLTON CRANSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 BROADWAY
NEWPORT RI
02840-2635
US

IV. Provider business mailing address

292 BROADWAY
NEWPORT RI
02840-2635
US

V. Phone/Fax

Practice location:
  • Phone: 401-200-2052
  • Fax:
Mailing address:
  • Phone: 401-200-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN58130
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: