Healthcare Provider Details

I. General information

NPI: 1407367469
Provider Name (Legal Business Name): JULIA POWERS VACA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DUDLEY ST
PROVIDENCE RI
02905-2401
US

IV. Provider business mailing address

193 SHAW AVE
CRANSTON RI
02905-3828
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-1122
  • Fax: 401-459-0108
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN52443
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: