Healthcare Provider Details

I. General information

NPI: 1427081140
Provider Name (Legal Business Name): MARSHA FITTRO PC,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 WAMPANOAG TRL
RIVERSIDE RI
02915-2206
US

IV. Provider business mailing address

184 WAMPANOAG TRL
RIVERSIDE RI
02915-2206
US

V. Phone/Fax

Practice location:
  • Phone: 401-435-5128
  • Fax: 401-270-4704
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number14926
License Number StateRI

VIII. Authorized Official

Name: MARSHA FITTRO
Title or Position: PRESIDENT
Credential: RN,MSN,BC,CDOE
Phone: 401-435-5128