Healthcare Provider Details

I. General information

NPI: 1891721510
Provider Name (Legal Business Name): JILL MORETTI PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KENYON AVE SUITE 326
WAKEFIELD RI
02879-4239
US

IV. Provider business mailing address

PO BOX 229
WAKEFIELD RI
02880-0229
US

V. Phone/Fax

Practice location:
  • Phone: 401-788-1277
  • Fax: 401-788-1514
Mailing address:
  • Phone: 401-788-3337
  • Fax: 401-788-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberPPNS00031
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: