Healthcare Provider Details

I. General information

NPI: 1770258451
Provider Name (Legal Business Name): DANIELLE MARTHA TREMBLAY REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVENUE D1071
PROVIDENCE RI
02908-4799
US

IV. Provider business mailing address

153 LAKESHORE DRIVE
BLACKSTONE MA
01504
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 617-549-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN277542
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN67636
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: