Healthcare Provider Details

I. General information

NPI: 1316032063
Provider Name (Legal Business Name): NICOLE JOY DURFEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE JOY WALKER

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

IV. Provider business mailing address

455 TOLL GATE RD
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-737-7000
  • Fax: 401-736-4546
Mailing address:
  • Phone: 401-737-7000
  • Fax: 401-736-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD11828
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number225850
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: