Healthcare Provider Details

I. General information

NPI: 1003630484
Provider Name (Legal Business Name): MY PLACE FOR MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 TOLL GATE RD STE 202
WARWICK RI
02886-4480
US

IV. Provider business mailing address

176 TOLL GATE RD STE 202
WARWICK RI
02886-4480
US

V. Phone/Fax

Practice location:
  • Phone: 401-363-6032
  • Fax: 401-384-7208
Mailing address:
  • Phone: 401-363-6032
  • Fax: 401-384-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MAUREEN A PLACE
Title or Position: FAMILY NURSE PRACTITIONER / OWNER
Credential: APRN, FNP-C
Phone: 401-363-6032