Healthcare Provider Details

I. General information

NPI: 1235049982
Provider Name (Legal Business Name): MARYLOUISE HARRISON RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CAMP DIXIE RD
PASCOAG RI
02859-2820
US

IV. Provider business mailing address

333 CAMP DIXIE RD
PASCOAG RI
02859-2820
US

V. Phone/Fax

Practice location:
  • Phone: 401-309-7953
  • Fax:
Mailing address:
  • Phone: 401-309-7953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN34504
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: