Healthcare Provider Details

I. General information

NPI: 1336215664
Provider Name (Legal Business Name): MAUREEN F. MCKONE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 KENYON AVE
WAKEFIELD RI
02879-4216
US

IV. Provider business mailing address

1463 FRENCHTOWN RD
EAST GREENWICH RI
02818-1310
US

V. Phone/Fax

Practice location:
  • Phone: 401-788-1277
  • Fax: 401-788-1514
Mailing address:
  • Phone: 401-339-2920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN38065
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: