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General NPI Number Information
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NPI Number | 1205350980
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Entity Type | Individual
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Provider Name | TABITHA ANN IMONDI PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 1525 OLD LOUISQUISSET PIKE STE 203
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City | LINCOLN
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State | RI
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Zip | 02865-4503
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Country | US
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Telephone | 774-291-0617
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Fax |
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Provider Business Mailing Address
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Address Line | 19 JEFFREY DR
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City | NORTH SCITUATE
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State | RI
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Zip | 02857-2939
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Country | US
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Telephone | 401-829-6788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN01646
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License Number State | RI
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