Healthcare Provider Details

I. General information

NPI: 1700289881
Provider Name (Legal Business Name): EMILY R MCCUE APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

IV. Provider business mailing address

345 BLACKSTONE BLVD
PROVIDENCE RI
02906-4800
US

V. Phone/Fax

Practice location:
  • Phone: 401-455-6357
  • Fax: 401-455-6566
Mailing address:
  • Phone: 401-455-6357
  • Fax: 401-455-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN01059
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: