Healthcare Provider Details

I. General information

NPI: 1114558244
Provider Name (Legal Business Name): CONSTANCE MARIE DUCHARME NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-4933
US

IV. Provider business mailing address

966 MINERAL SPRING AVE
NORTH PROVIDENCE RI
02904-4933
US

V. Phone/Fax

Practice location:
  • Phone: 401-475-3063
  • Fax: 401-475-0593
Mailing address:
  • Phone: 401-475-3063
  • Fax: 401-475-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN02253
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: