Healthcare Provider Details

I. General information

NPI: 1770302242
Provider Name (Legal Business Name): GLORIA BONGIORNO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGH SERVICE AVE
NORTH PROVIDENCE RI
02904-5113
US

IV. Provider business mailing address

42 BERKSHIRE DR
ALBION RI
02802-1112
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-3000
  • Fax:
Mailing address:
  • Phone: 401-374-6534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN04300
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2262916
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: