Healthcare Provider Details

I. General information

NPI: 1053040865
Provider Name (Legal Business Name): MARY JANE COTE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

V. Phone/Fax

Practice location:
  • Phone: 401-834-4005
  • Fax:
Mailing address:
  • Phone: 401-834-4005
  • Fax: 401-276-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN32565
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: