Healthcare Provider Details

I. General information

NPI: 1952814097
Provider Name (Legal Business Name): MARY HELEN RIDDLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2017
Last Update Date: 03/27/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BLACKSTONE STREET 2ND FLOOR
PROVIDENCE RI
02903-2759
US

IV. Provider business mailing address

PO BOX 3677
NASHUA NH
03061-3677
US

V. Phone/Fax

Practice location:
  • Phone: 401-453-7520
  • Fax: 401-453-7529
Mailing address:
  • Phone: 603-577-7900
  • Fax: 603-577-7972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02535
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN04457
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: