Healthcare Provider Details

I. General information

NPI: 1154572667
Provider Name (Legal Business Name): VERA LIVSHIN MSN, CNP, A-GNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CENTERVILLE RD
WARWICK RI
02886-4330
US

IV. Provider business mailing address

PO BOX 140
EAST WALPOLE MA
02032-0140
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-3332
  • Fax:
Mailing address:
  • Phone: 781-363-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN267562
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: