Healthcare Provider Details

I. General information

NPI: 1477208007
Provider Name (Legal Business Name): RACHEL LAVEY APRN-AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RACHEL LUSSIER

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN03623
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN54314
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: