=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326615246
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAOMI STASIA SIWY FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2021
-----------------------------------------------------
Last Update Date | 08/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 66 BRANCH AVE STE 150
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02904-2756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-606-2590
-----------------------------------------------------
Fax | 401-606-2591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 ELLENFIELD ST STE 101
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02905-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-444-6779
-----------------------------------------------------
Fax | 401-444-6912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | RN2287422
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN04181
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------