Healthcare Provider Details

I. General information

NPI: 1003677790
Provider Name (Legal Business Name): PRISCILLA K CUNHA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2024
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 EAST AVE
PAWTUCKET RI
02860-4003
US

IV. Provider business mailing address

50 ATLANTIC BLVD
NORTH PROVIDENCE RI
02911-1935
US

V. Phone/Fax

Practice location:
  • Phone: 401-312-0502
  • Fax:
Mailing address:
  • Phone: 401-601-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN69721
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: