Healthcare Provider Details

I. General information

NPI: 1093818957
Provider Name (Legal Business Name): BEVERLY J GENADER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVER ST
WAKEFIELD RI
02879-3214
US

IV. Provider business mailing address

450 CLINTON ST
WOONSOCKET RI
02895-3207
US

V. Phone/Fax

Practice location:
  • Phone: 401-783-0523
  • Fax: 401-782-0858
Mailing address:
  • Phone: 401-767-4100
  • Fax: 401-235-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37673
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: