Healthcare Provider Details

I. General information

NPI: 1154181980
Provider Name (Legal Business Name): RITA BLANKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 W RIVER ST FL 3
PROVIDENCE RI
02904-2609
US

IV. Provider business mailing address

10 DAVOL SQ STE 400
PROVIDENCE RI
02903-4752
US

V. Phone/Fax

Practice location:
  • Phone: 401-793-5700
  • Fax: 401-793-7801
Mailing address:
  • Phone: 401-444-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN03794
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: