Healthcare Provider Details

I. General information

NPI: 1164283065
Provider Name (Legal Business Name): LAUREN OLIVEIRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BAY VIEW AVE
RIVERSIDE RI
02915-4955
US

IV. Provider business mailing address

174 LYON AVE
EAST PROVIDENCE RI
02914-5134
US

V. Phone/Fax

Practice location:
  • Phone: 401-529-8884
  • Fax:
Mailing address:
  • Phone: 508-283-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN53719
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: