Healthcare Provider Details

I. General information

NPI: 1316803075
Provider Name (Legal Business Name): EDNA ILLEANA GOMEZ DUENAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 DIAMOND HILL RD STE 18
WOONSOCKET RI
02895-1554
US

IV. Provider business mailing address

PO BOX 746088
ATLANTA GA
30374-6088
US

V. Phone/Fax

Practice location:
  • Phone: 401-470-7116
  • Fax:
Mailing address:
  • Phone: 469-727-6675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN05040
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2324655
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: