Healthcare Provider Details

I. General information

NPI: 1780558437
Provider Name (Legal Business Name): CHIPO V NYAMUNDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 GENERAL ST
PROVIDENCE RI
02904-1650
US

IV. Provider business mailing address

127 RODNEY FRENCH BLVD UNIT 1-C40
NEW BEDFORD MA
02744-1623
US

V. Phone/Fax

Practice location:
  • Phone: 888-885-4522
  • Fax:
Mailing address:
  • Phone: 401-545-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2348368
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: