Healthcare Provider Details

I. General information

NPI: 1225435829
Provider Name (Legal Business Name): RALPH EUGENE APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SOCIAL ST STE 180
WOONSOCKET RI
02895-3213
US

IV. Provider business mailing address

191 SOCIAL ST STE 180
WOONSOCKET RI
02895-3213
US

V. Phone/Fax

Practice location:
  • Phone: 617-600-3195
  • Fax: 617-924-1207
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN03313
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2291275
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: