Healthcare Provider Details

I. General information

NPI: 1447050067
Provider Name (Legal Business Name): DIANE D'AMBRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 07/22/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

171 SERVICE AVE
WARWICK RI
02886-1014
US

V. Phone/Fax

Practice location:
  • Phone: 401-383-5150
  • Fax:
Mailing address:
  • Phone: 401-921-7386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number38272
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: