Healthcare Provider Details

I. General information

NPI: 1558455006
Provider Name (Legal Business Name): ETHEL MARIE MORIN RN, CDE, CDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 CASS AVE
WOONSOCKET RI
02895
US

IV. Provider business mailing address

319 QUAKER HIGHWAY
UXBRIDGE MA
01569
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-9355
  • Fax: 401-765-1721
Mailing address:
  • Phone: 508-278-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN25434
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: