Healthcare Provider Details

I. General information

NPI: 1366842346
Provider Name (Legal Business Name): YETUNDE OLUWATOYIN SHITTU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

3 CECELIA DR
JOHNSTON RI
02919-4718
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 401-942-9761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNPP37903
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: