Healthcare Provider Details

I. General information

NPI: 1891093274
Provider Name (Legal Business Name): DONNA M. ANDERSON BSRN, CDOE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 CASS AVE
WOONSOCKET RI
02895-4712
US

IV. Provider business mailing address

30 KING ST
UXBRIDGE MA
01569-2120
US

V. Phone/Fax

Practice location:
  • Phone: 401-769-9355
  • Fax: 401-765-1721
Mailing address:
  • Phone: 508-278-6182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN26015
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: