Healthcare Provider Details

I. General information

NPI: 1275813248
Provider Name (Legal Business Name): JANINE MARY MEDEIROS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 EAST AVE
PAWTUCKET RI
02860-4003
US

IV. Provider business mailing address

39 EAST AVE
PAWTUCKET RI
02860-4003
US

V. Phone/Fax

Practice location:
  • Phone: 401-722-0081
  • Fax: 13-120-3184
Mailing address:
  • Phone: 401-722-0081
  • Fax: 13-120-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2263949
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37650
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberNPP37650
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00052
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: