Healthcare Provider Details

I. General information

NPI: 1760325492
Provider Name (Legal Business Name): JIANNA ALYSSA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 PAUL ST
PROVIDENCE RI
02904-1354
US

IV. Provider business mailing address

21 REDWING ST
PROVIDENCE RI
02907-1721
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-9369
  • Fax:
Mailing address:
  • Phone: 401-391-5357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: