Healthcare Provider Details

I. General information

NPI: 1912360397
Provider Name (Legal Business Name): LUTSIYA HUANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LUTSIYA IMBRAGIMOVA

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 MINERAL SPRING AVE STE 107
NORTH PROVIDENCE RI
02904-4042
US

IV. Provider business mailing address

1637 MINERAL SPRING AVE SUITE 107
NORTH PROVIDENCE RI
02904-4042
US

V. Phone/Fax

Practice location:
  • Phone: 401-354-4400
  • Fax: 401-354-4474
Mailing address:
  • Phone: 401-354-4400
  • Fax: 401-354-4474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00892
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: