Healthcare Provider Details

I. General information

NPI: 1265107023
Provider Name (Legal Business Name): ALICIA VATTER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALICIA SALISBURY FNP-C

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 TOLL GATE RD STE 206A
WARWICK RI
02886-4461
US

IV. Provider business mailing address

750 RESERVOIR AVE
CRANSTON RI
02910-4423
US

V. Phone/Fax

Practice location:
  • Phone: 401-490-4515
  • Fax: 401-490-4516
Mailing address:
  • Phone: 401-943-0761
  • Fax: 401-943-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN02781
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: