Healthcare Provider Details

I. General information

NPI: 1710089883
Provider Name (Legal Business Name): MICHELINE LISE POIRIER-WOOLF NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BALD HILL RD STE 511
WARWICK RI
02886-6100
US

IV. Provider business mailing address

42 MACINTOSH LN
SAUNDERSTOWN RI
02874-1938
US

V. Phone/Fax

Practice location:
  • Phone: 401-738-8100
  • Fax: 401-732-2763
Mailing address:
  • Phone: 401-294-7054
  • Fax: 401-732-2763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP30927
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: