Healthcare Provider Details

I. General information

NPI: 1538766415
Provider Name (Legal Business Name): JAMES VINCENT LEMIEUX RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
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: 401-737-7010
  • Fax: 401-736-4546
Mailing address:
  • Phone: 401-737-7010
  • Fax: 401-736-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN02656
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: