Healthcare Provider Details

I. General information

NPI: 1710227269
Provider Name (Legal Business Name): MELISSA ELAINE DIVOLL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ELAINE VALDEZ RRT

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 FRIENDSHIP ST STE 150-160
NEWPORT RI
02840-2272
US

IV. Provider business mailing address

19 FRIENDSHIP ST STE 150-160
NEWPORT RI
02840-2272
US

V. Phone/Fax

Practice location:
  • Phone: 401-845-3800
  • Fax: 401-845-1075
Mailing address:
  • Phone: 401-845-3800
  • Fax: 401-845-1075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN03882
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT10429
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberTH2000
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: