Healthcare Provider Details

I. General information

NPI: 1174452999
Provider Name (Legal Business Name): ANDREA SEARS CHW/CPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PLEASANT ST
PROVIDENCE RI
02906-1715
US

IV. Provider business mailing address

115 JUNIPER ST
EAST PROVIDENCE RI
02914-5406
US

V. Phone/Fax

Practice location:
  • Phone: 401-837-3974
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number201875
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: