Healthcare Provider Details

I. General information

NPI: 1417264433
Provider Name (Legal Business Name): MALGORZATA A. RACZKOWSKA RN, CDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COASTWAY BLVD
WARWICK RI
02886-0006
US

IV. Provider business mailing address

375 ALLENS AVE
PROVIDENCE RI
02905-5010
US

V. Phone/Fax

Practice location:
  • Phone: 401-415-4962
  • Fax: 401-780-0689
Mailing address:
  • Phone: 401-444-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN48317
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: