Healthcare Provider Details

I. General information

NPI: 1306454368
Provider Name (Legal Business Name): AMANDA PRYMAK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WEBSTER ST
PAWTUCKET RI
02861-1168
US

IV. Provider business mailing address

435 MAUREEN CIR
MAPLEVILLE RI
02839-1141
US

V. Phone/Fax

Practice location:
  • Phone: 603-723-6622
  • Fax:
Mailing address:
  • Phone: 603-723-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN64460
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: