Healthcare Provider Details

I. General information

NPI: 1699917260
Provider Name (Legal Business Name): BRENDA COUTU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2009
Last Update Date: 03/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WAMPANOAG TRL
RIVERSIDE RI
02915-1504
US

IV. Provider business mailing address

610 WAMPANOAG TRL
RIVERSIDE RI
02915-1504
US

V. Phone/Fax

Practice location:
  • Phone: 401-431-9870
  • Fax:
Mailing address:
  • Phone: 401-431-9870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN26782
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: