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General NPI Number Information
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NPI Number | 1114811718
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Entity Type | Organization
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Legal Business Name | BANNER HEALTH AND WELLNESS
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 1559 HARTFORD AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-3225
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Country | US
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Telephone | 401-585-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 1559 HARTFORD AVE
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City | JOHNSTON
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State | RI
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Zip | 02919-3225
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Country | US
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Telephone | 401-332-9444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOY LELIA LATORRE
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Credential |
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Telephone | 401-332-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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