Healthcare Provider Details

I. General information

NPI: 1144358458
Provider Name (Legal Business Name): PAULETTE J MOLIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PEACE ST
PROVIDENCE RI
02907-1510
US

IV. Provider business mailing address

11 RAYMOND ST
LINCOLN RI
02865-2219
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-4521
  • Fax:
Mailing address:
  • Phone: 401-334-2104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN14764
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: