Healthcare Provider Details

I. General information

NPI: 1508898909
Provider Name (Legal Business Name): FAIRLAWN PRIMARY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 MINERAL SPRING AVE
PAWTUCKET RI
02860-3322
US

IV. Provider business mailing address

886 MINERAL SPRING AVE
PAWTUCKET RI
02860-3322
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number09843
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37132
License Number StateRI

VIII. Authorized Official

Name: MS. HOLLY FERNANDES
Title or Position: PRESIDENT
Credential:
Phone: 401-475-3063