Healthcare Provider Details

I. General information

NPI: 1538397716
Provider Name (Legal Business Name): CHRISTINE ANN NEVINS-HERBERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

IV. Provider business mailing address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4200
  • Fax: 401-312-2356
Mailing address:
  • Phone: 401-415-4200
  • Fax: 401-312-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCMD14268
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberCMD14268
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: