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General NPI Number Information
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NPI Number | 1154807717
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Entity Type | Organization
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Legal Business Name | OCEAN STATE PRIMARY, LLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 300 TOLL GATE RD STE 101B
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City | WARWICK
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State | RI
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Zip | 02886-4447
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Country | US
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Telephone | 401-921-5855
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Fax |
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Provider Business Mailing Address
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Address Line | 2130 MENDON RD STE 3-333
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City | CUMBERLAND
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State | RI
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Zip | 02864-3844
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Country | US
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Telephone | 401-353-1012
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | JENNIFER ZUBA
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Credential |
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Telephone | 401-626-2748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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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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