Healthcare Provider Details

I. General information

NPI: 1780063628
Provider Name (Legal Business Name): JEANNETTE M SORACE-BURTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

44 GRINNELL AVE
TIVERTON RI
02878-1902
US

V. Phone/Fax

Practice location:
  • Phone: 401-276-4112
  • Fax:
Mailing address:
  • Phone: 781-234-4981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN254301
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN254301
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN01925
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: