Healthcare Provider Details

I. General information

NPI: 1922703123
Provider Name (Legal Business Name): DEBORAH J CANNING RN,CDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 DUDLEY ST
PROVIDENCE RI
02905-3233
US

IV. Provider business mailing address

101 DUDLEY ST
PROVIDENCE RI
02905-2499
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7950
  • Fax: 402-453-7748
Mailing address:
  • Phone: 401-274-1100
  • Fax: 401-453-7748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN30996
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: