Healthcare Provider Details

I. General information

NPI: 1689667370
Provider Name (Legal Business Name): DIANE BROUSSEAU-PIZZI PCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 REVERE AVE
WEST WARWICK RI
02893-3938
US

IV. Provider business mailing address

125 REVERE AVE
WEST WARWICK RI
02893-3938
US

V. Phone/Fax

Practice location:
  • Phone: 401-965-1947
  • Fax:
Mailing address:
  • Phone: 401-965-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberPNS00015
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN23411
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: