Healthcare Provider Details

I. General information

NPI: 1083720502
Provider Name (Legal Business Name): NANCY LOUISE HARRITOS RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LOUISE GAUTREAUX MS, RNP

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHAPMAN ST STE 300
PROVIDENCE RI
02905-4539
US

IV. Provider business mailing address

117 ELLENFIELD ST STE 101
PROVIDENCE RI
02905-4541
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4741
  • Fax: 401-444-4445
Mailing address:
  • Phone: 401-444-6779
  • Fax: 401-444-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN24139
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00449
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: