Healthcare Provider Details

I. General information

NPI: 1609899608
Provider Name (Legal Business Name): CARMEN B LYSAGHT MSN RNCS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD ROAD ASSOCIATES IN PSYCHOTHERAPY SUITE E204
NORTH KINGSTOWN RI
02852-4158
US

IV. Provider business mailing address

1130 TEN ROD ROAD ASSOCIATES IN PSYCHOTHERAPY SUITE E204
NORTH KINGSTOWN RI
02852-4158
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-9600
  • Fax: 401-295-7395
Mailing address:
  • Phone: 401-294-9600
  • Fax: 401-295-7395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN29243
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: