Healthcare Provider Details

I. General information

NPI: 1558018259
Provider Name (Legal Business Name): JACQUELINE A PROCOPIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 LAKEDELL DR
WARWICK RI
02818
US

IV. Provider business mailing address

191 LAKEDELL DR
WARWICK RI
02818
US

V. Phone/Fax

Practice location:
  • Phone: 401-338-0478
  • Fax:
Mailing address:
  • Phone: 401-338-0478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: