Healthcare Provider Details

I. General information

NPI: 1174117022
Provider Name (Legal Business Name): MISS ALEXIS VERA DENGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 COLLYER ST
PROVIDENCE RI
02904-1869
US

IV. Provider business mailing address

195 COLLYER ST
PROVIDENCE RI
02904-1869
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-7799
  • Fax:
Mailing address:
  • Phone: 401-272-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number03426
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: