Healthcare Provider Details

I. General information

NPI: 1548149594
Provider Name (Legal Business Name): NICOLE DEANGELIS PMH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

38 CAPTAIN JOHN JACOBS RD APT 202
EAST PROVIDENCE RI
02914-5383
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6356
  • Fax:
Mailing address:
  • Phone: 401-450-7384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN04769
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN69971
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: