Healthcare Provider Details

I. General information

NPI: 1528051372
Provider Name (Legal Business Name): PATRICIA JEAN STARK NPP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 DIAMOND HILL RD
WOONSOCKET RI
02895-1541
US

IV. Provider business mailing address

16 AUDUBON RD
WARWICK RI
02888-4602
US

V. Phone/Fax

Practice location:
  • Phone: 401-762-1511
  • Fax:
Mailing address:
  • Phone: 401-467-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPP37190
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: