Healthcare Provider Details

I. General information

NPI: 1942358106
Provider Name (Legal Business Name): JUDITH SHARON BESSOFF ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 KILVERT ST
WARWICK RI
02886-1379
US

IV. Provider business mailing address

116 BLAISDELL AVE
PAWTUCKET RI
02860-5751
US

V. Phone/Fax

Practice location:
  • Phone: 401-714-6094
  • Fax:
Mailing address:
  • Phone: 401-465-0346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPP30348
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: