Healthcare Provider Details

I. General information

NPI: 1386992741
Provider Name (Legal Business Name): BETSY LONERGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2012
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST POB 224
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST HASBRO 122
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-6118
  • Fax: 401-444-8804
Mailing address:
  • Phone: 401-444-6118
  • Fax: 401-444-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN38820
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: