Healthcare Provider Details

I. General information

NPI: 1568887420
Provider Name (Legal Business Name): ALISHA RIOLES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BACON ST
PAWTUCKET RI
02860-5542
US

IV. Provider business mailing address

101 BACON ST
PAWTUCKET RI
02860-5542
US

V. Phone/Fax

Practice location:
  • Phone: 401-724-8400
  • Fax: 401-722-5280
Mailing address:
  • Phone: 401-724-8400
  • Fax: 401-722-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN52296
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: