Healthcare Provider Details

I. General information

NPI: 1619059425
Provider Name (Legal Business Name): PATRICIA M REPOSA APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTERVILLE ROAD SUMMIT WEST SUITE 101
WARWICK RI
02886
US

IV. Provider business mailing address

300 CENTERVILLE ROAD SUMMIT WEST SUITE 101
WARWICK RI
02886
US

V. Phone/Fax

Practice location:
  • Phone: 401-732-4500
  • Fax: 401-732-7766
Mailing address:
  • Phone: 401-732-4500
  • Fax: 401-732-7766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN19548
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: