Healthcare Provider Details

I. General information

NPI: 1649272162
Provider Name (Legal Business Name): HOLLY FERNANDES RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 07/08/2007
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: 401-475-0593
Mailing address:
  • Phone: 401-475-3063
  • Fax: 401-475-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37132
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: