Healthcare Provider Details

I. General information

NPI: 1215915228
Provider Name (Legal Business Name): DEBBIE MENDELSOHN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 SUMMIT AVE
PROVIDENCE RI
02906-2853
US

IV. Provider business mailing address

206 ELMGROVE AVE
PROVIDENCE RI
02906-4233
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-4500
  • Fax:
Mailing address:
  • Phone: 401-751-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberAPRN00843
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: