Healthcare Provider Details

I. General information

NPI: 1720165582
Provider Name (Legal Business Name): BARBARA DUFFY EVANS GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

IV. Provider business mailing address

1085 N MAIN ST
PROVIDENCE RI
02904-5719
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4212
  • Fax: 401-415-4348
Mailing address:
  • Phone: 401-415-4212
  • Fax: 401-415-4348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNPP36692
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: