Healthcare Provider Details

I. General information

NPI: 1376333229
Provider Name (Legal Business Name): STACY MONTEIRO MENDES CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SOCIAL ST STE 100
WOONSOCKET RI
02895-3213
US

IV. Provider business mailing address

191 SOCIAL ST STE 100
WOONSOCKET RI
02895-3213
US

V. Phone/Fax

Practice location:
  • Phone: 401-597-6500
  • Fax: 814-339-6165
Mailing address:
  • Phone: 401-597-6500
  • Fax: 814-339-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN78538
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCAPRN04793
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: