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General NPI Number Information
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NPI Number | 1134043946
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Entity Type | Organization
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Legal Business Name | NORTHSTAR MEDICAL WELLNESS LLC
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 90 TOMAQUAG VALLEY RD
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City | BRADFORD
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State | RI
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Zip | 02808-1720
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Country | US
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Telephone | 401-601-6544
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Fax |
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Provider Business Mailing Address
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Address Line | 13 AIRPORT RD STE 1014
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City | WESTERLY
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State | RI
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Zip | 02891-3401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | REBECCA BERRY
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Credential | FNP-C
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Telephone | 401-601-6544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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