Healthcare Provider Details

I. General information

NPI: 1457019721
Provider Name (Legal Business Name): STEFANIE DIAS MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2021
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 POWEL AVE
NEWPORT RI
02840
US

IV. Provider business mailing address

20 POWEL AVE
NEWPORT RI
02840
US

V. Phone/Fax

Practice location:
  • Phone: 401-845-1190
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN02836
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02836
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: