Healthcare Provider Details

I. General information

NPI: 1154938744
Provider Name (Legal Business Name): DALE SUMILANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CHESTNUT ST
PROVIDENCE RI
02903-4169
US

IV. Provider business mailing address

111 CHESTNUT ST
PROVIDENCE RI
02903-4169
US

V. Phone/Fax

Practice location:
  • Phone: 401-262-9964
  • Fax:
Mailing address:
  • Phone: 401-262-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN02624
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN50764
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: