Healthcare Provider Details

I. General information

NPI: 1205804218
Provider Name (Legal Business Name): LINDA LEE GADOURY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 TEN ROD RD THE MEADOWS BLDG D 305A
NORTH KINGSTOWN RI
02852-4161
US

IV. Provider business mailing address

54 SHARPE ST
WEST GREENWICH RI
02817-2100
US

V. Phone/Fax

Practice location:
  • Phone: 401-294-8231
  • Fax:
Mailing address:
  • Phone: 401-397-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN14971
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: