Healthcare Provider Details

I. General information

NPI: 1083647044
Provider Name (Legal Business Name): MARIANNE BATES RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

80 FAIROAKS AVE
PROVIDENCE RI
02908-2826
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax: 401-525-2523
Mailing address:
  • Phone: 401-273-7100
  • Fax: 401-525-2523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberLDN00328
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: